Publication:

Radiological evidence of regeneration in bilateral humeral head avascular necrosis following bone marrow aspirate concentrate augmented core decompression: a case report

Avascular necrosis (AVN) of the humeral head is an uncommon but potentially debilitating orthopaedic condition characterized by compromised blood supply to the subchondral bone, leading to bone ischemia, structural collapse, and progressive joint dysfunction. In early stages, the disease may remain asymptomatic or present with mild shoulder pain; however, with disease progression functional impairment is evident. Early diagnosis and timely intervention are essential to prevent joint collapse and arthroplasty. Regenerative strategies using Orthobiologics aim to enhance bone repair, restore vascularity, and preserve joint integrity. We report the case of a 60-year-old female presenting with bilateral humeral head AVN without subchondral collapse. The patient underwent percutaneous core decompression (PCD) augmented with autologous bone marrow aspirate concentrate (BMAC) under fluoroscopic-guided suprascapular nerve block. At eight months post-intervention, the patient demonstrated significant clinical and radiological improvement. Pain, measured using the visual analogue scale (VAS), decreased from 8/10 pre-procedure to 1/10 post-procedure. Functional outcomes assessed by the Constant-Murley shoulder score (CMS) improved from 36 (right) and 42 (left) pre-procedure to 85 (right) and 81 (left) post-procedure. Follow-up magnetic resonance imaging (MRI) revealed marked resolution of subchondral altered marrow signal intensity in both humeral heads, indicating structural recovery without evidence of cortical collapse. Early-stage humeral head AVN without subchondral collapse can be effectively managed using PCD combined with autologous BMAC augmentation. This minimally invasive regenerative approach may promote biological repair, alleviate pain, and restore function, thereby serving as a joint-preserving alternative to arthroplasty in selected patients.