• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.174-178
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• 2009

Purpose: We introduce arthroscopic assisted core decompression for humeral head osteonecrosis. Operative technique: After diagnostic shoulder arthroscopy is performed using posterior and anterior portal, we make a 2 cm lateral skin incision approximately 3 cm distal to 1/3 of lateral margin of the acromion and place short gray cannula to prevent adjacent soft tissue injury when insert guide pin. Under C-arm fluoroscopic and arthroscopic guidance, 3 to 4 guide pins are inserted toward the necrotic area. Then we perform drilling using 7.0 mm reamer. Conclusion: We believe this technique is a less invasive approach and avoids the complications comparing to deltopectoral approach. Arthroscopic assisted core decompression is an effective procedure in management of early stage of the humeral head osteonecoris.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.191-204
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• 2023

Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.