VOL. 91-B, No. 4, APRIL 2009 499 Osteochondral autologous transplantation for the treatment of full-thickness cartilage defects of the shoulder RESULTS AT NINE YEARS J. Kircher, T. Patzer, P. Magosch, S. Lichtenberg, P. Habermeyer From the ATOS Clinic, Heidelberg, Germany ! J. Kircher, MD, Consultant Orthopaedic Surgeon ! T. Patzer, MD, Orthopaedic Registrar ! P. Magosch, MD, Orthopaedic Registrar ! S. Lichtenberg, MD, Consultant Orthopaedic Surgeon ! P. Habermeyer, MD, PhD, Professor Heidelberg Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, D-69115, Heidelberg, Germany. Correspondence should be sent to Dr J. Kircher; e-mail: kircher@atos.de '2009 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.91B4. 21838 $2.00 J Bone Joint Surg [Br] 2009;91-B:499-503. Received 29 September 2008; Accepted 5 January 2009 We describe the outcome at a mean follow-up of 8.75 years (7.6 to 9.8) of seven patients who had undergone osteochondral autologous transplantation for full-thickness cartilage defects of the shoulder between 1998 and 2000. These patients have been described previously at a mean of 32.6 months when eight were included. One patient has been lost to follow-up. The outcome was assessed by the Constant shoulder score and the Lysholm knee score to assess any donor-site morbidity. Standard radiographs and MR scores were obtained and compared with the pre-operative findings and the results from the previous review. No patient required any further surgery on the shoulder. The mean Constant score improved significantly until the final follow-up (p = 0.018). The Lysholm score remained excellent throughout. There was a significant progression of osteoarthritic changes from the initial surgery to the first and final follow-up but this did not appear to be related to the size of the defect, the number of cylinders required or the Constant score (p = 0.016). MRI showed that all except one patient had a congruent joint surface at the defect with full bony integration of all osteochondral cylinders. The results have remained satisfactory over a longer period with very good objective and subjective findings. The incidence of defects of the articular carti- lage of the shoulder is estimated to be between 5% and 17% in athletes engaged in overhead sporting activity. Treatment remains a problem because of the limited capacity for repair. 1,2 The fibrocartilaginous repair stimulated by microfracture, drilling and abrasion chondro- plasty lacks the resilience of hyaline cartilage. 3-5 Autologous chondrocyte implantation (ACI) as introduced by Brittberg et al 6 for the treat- ment of lesions at the knee has been developed with the addition of matrix or scaffold- associated techniques for use in clinical prac- tice. 7-9 These methods often require a two- stage procedure and are expensive. It remains uncertain whether long-lasting hyaline-like cartilage can be generated. 10-15 The use of structural allografts for the treat- ment of osteochondral defects at the knee and shoulder has been described, but not in con- trolled studies with sufficient numbers to draw conclusions about the outcome. 16-19 An alterna- tive is the transplantation of autologous carti- lage in conjunction with the underlying bone for small defects. 20,21 It has been shown that the pri- mary stability of the osteochondral cylinders increases with the size and the use of bigger cylinders of 8 mm to 12 mm. 22,23 The method has been described for almost all the large joints. 24-33 Although usually there are no prob- lems with bony ingrowth, it should be noted that healing does not occur at the interface between the host cartilage and the transplanted cylinders. 12,34-36 We reported the use of this tech- nique at the shoulder in a series of eight patients with good short-term results 37 and it is also reported in an isolated case report. 38 Our aim in this study was the re-evaluation of our series after a longer follow-up in regard to the clinical results and the development of osteoarthritis. Patients and Methods Seven patients from the initial series were re- assessed at a mean follow-up of 8.75 years (7.6 to 9.8) by clinical examination and scoring, and standard radiography comprising true antero- posterior (AP) views in neutral, internal and external rotation and an axillary view, as well as by MRI. One patient had been lost to follow-up because of problems involving the donor site at the ipsilateral knee. This patients refused an invitation to re-attend, but reported his satisfac- tion with the shoulder and no current problem with his knee during a telephone interview.