Arthroscopically Assisted Fibular Strut Allograft for Treatment of Osteonecrosis of Proximal Humerus

Fourteen patients (17 shoulders) were identified who had been treated by one surgeon from 1992 to 2008 for symptomatic shoulder osteonecrosis using proximal humerus core decompression with fibular allograft strut placement. Pre- and postoperative radiographs were available, along with active range of motion and postoperative function: SPADI, ASES, SF-12. Two patients (two shoulders) were lost to follow-up. Radiographs were staged using the Cruess classification system as eight precollapse (stages I and II) (mean age 44 years) and six postcollapse shoulders (stages III and IV) (mean age 30 years). Groups had similar preoperative and postoperative flexion, external rotation, and functional scores. Two stage II shoulders and one stage IV shoulder were subsequently converted to hemiarthroplasty. This minimally invasive surgical technique could expand indications for strut grafting and joint salvage to treatment of patients with advanced osteonecrosis.