Osteonecrosis of the shoulder is a devastating disease, particularly in the young patient. Published data is replete with vascularized and nonvascularized bone grafting procedures for joint preservation of the hip; however, these same techniques have not been applied to the shoulder. When treating osteonecrosis of the shoulder, endoscopically-guided thorough debridement of the necrotic bone may promote good outcomes by ensuring that the bone graft, vascularized or nonvascularized, is stabilized against a viable host bed. In addition, this new technique facilitates access to the subchondral plate from the osseous side, thereby fully debriding the intraosseous fracture and allowing elevation of the articular surface if needed. When collapse is present, stage 3 disease secondary articular-sided changes may be present and should be addressed during concomitant arthroscopy. This article presents a case of endoscopically-guided thorough debridement of the humeral head combined with nonvascularized bone grafting of the residual cavity and stabilization, and concomitant arthroscopy for a 30-year-old woman with steroid-associated osteonecrosis.
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