Fresh Osteochondral Allografts in Orthopedics Affect Patient Care

Question: How have you used fresh allografts in new or innovative ways?

Matthew Provencher, MD: Traditionally, fresh osteochondral allografts have been used in and around the knee joint. They were first described for use in the condyles of the knee, but the indications have since expanded due to additional allograft availability, improved instrumentation, and demonstration of good long-term outcomes. I’ve expanded the allograft technology to use in multiple other joints, such as using ankle allograft tissue for shoulder reconstructive procedures. For example, we were the first to describe the use of a fresh distal tibial allograft for reconstruction of glenoid bone defects. This has been done since 2008 with very promising results both clinically as well as healing on computed tomography scan demonstrating solid incorporation.

Due to the favorable clinical outcomes of fresh distal tibial allograft to the glenoid, we have also started to utilize fresh talus allograft for large Hill-Sachs lesions as well as reverse Hill-Sachs injuries. The reason for utilizing talar allograft for the humerus is: 1) we have shown that the talus fits well for both typical Hill-Sachs and reverse Hill-Sachs lesions; 2) the ready availability of talus grafts (sometimes within one to two weeks); and 3) no need for size matching, much like the fresh distal tibia, which is also not size matched. The talus has to be cut in a special manner in order to accommodate the correct sizing and fit for the Hill-Sachs. We have found that the curvature, as well as potential for cartilage restoration particularly beneficial, especially in the setting of a reverse Hill Sachs.

After doing the sizing and contouring work, we found you have to make cuts in the correct area to obtain a congruent fit between talus and humerus. The curvature matches very well and since the talus is comprised of dense corticocancellous bone, this incorporates well and is a robust construct. We also utilize headless compression screws to ensure that the graft is compressed well after final fit is obtained.

Full Article: How Innovative Fresh Osteochondral Allografts in Orthopedics Affect Patient Care

Matthew Provencher, MD

Average rating:

64 reviews

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

THEODORE Wirecki

by THEODORE Wirecki on Matthew Provencher, MD

My reverse shoulder replacement

I had my reverse shoulder replacement with Dr.Provencher four months ago. Took an hour, home an hour later. No pain with the meds cocktail, ice machine, and lidocaine pump. My recovery was incredible quick and effortless, no pain and good range of motion. Dr.Provencher is really the best surgeon, and a genuine and kind human being. If you are able to have Dr. Provencher do your shoulder you would be a fool to go anywhere else. The Steadman Clinic is state of the art, extremely efficient, using tranexamic acid intravenously right before surgery to minimize bleeding and many other sophisticated strategies not available in community hospitals. The process and the outcome way exceeded my expectations. If you would like more detail about the experience email me or call on my cell, 3036182303.
Ted Wirecki MD

Alvin Hrubes

Feb 1, 2023

by Alvin Hrubes on Matthew Provencher, MD

My shoulder was ruined in a car accident. I am 82 years old and Dr. Provencher did more than I had ever hoped for. He did a reverse shoulder and at 2 weeks the range of motion exceeded what I had before replacement. He is my hero! Thank you, Dr. Provencher!!

Knee | Shoulder | Joint Preservation | Arthroplasty

SCHEDULE APPOINTMENT

MRI/X-RAY REVIEW

ASK A QUESTION

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel