When allografts fail for instability surgery-what to do?

Rachel M. Frank, Stephen Parada, Randy Mascarenhas, Anthony A. Romeo

Research output: Contribution to journalArticlepeer-review


The glenohumeral joint is a highly congruous articulation that is dependent on the osseous integrity of both the glenoid rim and the humeral head. Disruptions in the bony architecture of either surface occur in up to 100% of shoulders in the setting of recurrent anterior shoulder instability. Unrecognized, as well as underappreciated, glenoid bone loss in the setting of glenohumeral instability is especially problematic. As bone loss approaches 20% or more of the glenoid surface area, surgical strategies tend to incorporate a bony reconstruction, with either an autograft or an allograft. Similarly, bone defects of greater than 25%-30% of the humeral head tend to warrant surgical treatment; although often in this setting, reconstruction of the glenoid restores smooth articulation with the humeral head, despite the defect, and no further treatment is required. Although short-term outcomes following allograft reconstruction of the glenohumeral joint are encouraging, given the relatively few medium- and long-term reports available, it is difficult to draw conclusions as to how these procedures fare over time. Cases of recurrent instability despite appropriate allograft reconstruction exist, and surgical options are typically salvage-type procedures, limited to revision allograft reconstruction or arthroplasty. This review focuses on the indications for allograft reconstruction of the glenohumeral joint, definition of and workup of patients experiencing recurrent instability following allograft augmentation, and treatment options for these difficult patients. A treatment algorithm summarizing the authors' recommended management of these patients has also been provided.

Original languageEnglish (US)
Pages (from-to)43-51
Number of pages9
JournalOperative Techniques in Sports Medicine
Issue number1
StatePublished - Mar 1 2015
Externally publishedYes


  • Allograft
  • Bone augmentation
  • Revision stabilization
  • Shoulder instability

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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