Humeral head and distal tibia osteochondral allograft for bipolar bone loss in the setting of anterior shoulder instability from seizure disorder.

Background: Bipolar bone loss in patients with recurrent anterior shoulder instability secondary to epileptic seizures is a complex problem. There is no consensus on the preferred surgical management strategy in these patients. The purpose of our study is to describe an allograft-based reconstruction technique for bipolar bone loss using a distal tibia osteochondral allograft for reconstructing anterior glenoid bone loss and a humeral head osteochondral allograft to reconstruct posterior humeral head bone loss in patients with shoulder instability and seizures. Methods: A total of 3 patients (4 shoulders) with a history of recurrent shoulder instability relating to seizure disorder with bipolar bone loss were included from the years 2021 to 2024. Patients were treated surgically with osteochondral allograft including distal tibia allograft for anterior glenoid bone loss and humeral head for the large Hill-Sachs lesion to restore shoulder stability. Postoperative outcomes included patient-reported outcome measures, range of motion, dynamic digital radiography, complications, and failures. Results: Patient ages ranged from 25 to 34 year old with mean follow-up time of 32.7 months. The mean instability severity index score was 4.5 and with >30% bipolar bone defects. At follow-up all patients reported a resting visual analog score of zero, a subjective shoulder value of 93.8% (range: 90%-100%), a mean American Shoulder Elbow Surgeons score of 97.5 (range: 94-100). There were no repeat dislocations, episodes of postoperative instability, postoperative complications (neurological deficits or infection), or graft failures. Conclusion: Humeral head and distal tibia osteochondral allograft use in combination for reconstructing bipolar bone loss of the shoulder in patients with epilepsy is a promising treatment strategy with excellent patient outcomes.