Biological Resurfacing of the Humerus in the Athlete

Biological resurfacing of the humeral head may be needed in treating young athletes with cartilage defects associated with osteochondritis dissecans, posttraumatic cartilage injuries, postsurgical defects, avascular necrosis, and idiopathic cartilage defects. Patients must first undergo an extensive trial of nonoperative treatment and arthroscopic debridement before considering biologic resurfacing. Biologic resurfacing can be performed with autologous chondrocyte repair, osteochondral allograft, or osteochondral autograft. A size-matched osteochondral allograft lacks the donor-site morbidity associated with autograft techniques. Adequate preoperative imaging is critical to obtaining an appropriate allograft. Although arthroscopic treatment is often successful, biologic resurfacing of the humeral head with a size-matched osteochondral allograft is indicated in the rare cases in which symptoms persist. Prosthetic replacement is preferable in older patients or those with nonlocalized disease.