Chondral defects of the glenohumeral joint

Abstract

IntroductionAn increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement.Materials and methodsPatients (n = 32) who had received microfracturing of the shoulder were retrospectively enrolled, of whom 5 had received shoulder replacements after a mean time of 47 months. Of these patients, 23 completed the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant–Murley Scores in addition to an additional subjective questionnaire. Patients were then clinically examined and received x‑ray analysis of the operated shoulder. Data from an additional 4 patients were acquired by telephone interview.ResultsMean follow-up was 105 months. Of the included patients, 13/27 patients reported no pain, 12/27 patients moderate pain. Of these 12, 6/27 reported pain only at night and 3/27 only during rest. Concerning the outcome of surgery, 19/27 patients were “satisfied” or “very satisfied”. There was a statistically significant increase in internal rotation, but no further differences in the range of motion pre- and postoperatively. Patients without any signs of osteoarthritis before surgery showed statistically significantly better outcomes. There was a statistically significant increase in radiological signs of osteoarthrosis in pre- versus postoperative patients. Patients with bipolar lesions showed statistically significantly poorer Subjective Shoulder Value (SSV) results.ConclusionEven though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty.

Glenohumeral Microfracturing of Contained Glenohumeral Defects: Mid- to Long-term Outcome

“…However, both of the patients requiring revision surgery had isolated (1 humeral and 1 glenoidal) and not bipolar lesions. Another recent study by Hünnebeck et al 25 is widely in accordance with our data, describing very satisfying clinical long-term outcome following glenohumeral microfracturing. However, they also reported less favorable outcome when lesions were bipolar.…”

“…Another recent study by Hünnebeck et al. 25 is widely in accordance with our data, describing very satisfying clinical long-term outcome following glenohumeral microfracturing. However, they also reported less favorable outcome when lesions were bipolar.…”

“…Some studies suggest that arthroscopic management is more successful in shoulders with an isolated humeral defect. [24][25][26] A study by Kerr and McCarty 24 compared patients with unipolar and bipolar lesions after arthroscopic debridement proving patients with unipolar lesions had higher outcome scores than those with bipolar lesions. Similarly, we detected slightly better Constant Score and Oxford Shoulder Score for isolated humeral compared with bipolar lesions.…”

Does the Presence of Chondral Lesions Negatively Affect Patient-Determined Outcomes After Arthroscopic Rotator Cuff Repair?

“…However, the methodology of our study was not designed to determine if operative treatment of chondral lesions was effective, as it was limited by selection bias (subjective decision making by the surgeon to perform cartilage treatment) and small sample size (17 chondroplasties, 9 microfractures). Regardless of this, multiple studies 2 , 3 , 7 , 8 , 19 , 22 – 24 have demonstrated the effectiveness of both chondroplasty and microfracture in the treatment of chondral damage. Similar to our study, Kerr and McCarty 10 demonstrated that when treating chondral injuries without rotator cuff tears, outcomes were similar regardless of whether the Outerbridge classification was grade 2-3 or grade 4.…”

Optimal management of glenohumeral osteoarthritis

“…In general, the size of the lesion dictates treatment. Small, superficial osteochondral defects can be treated with micro-fracture and debridement 60. Cameron et al reported 88% of patients experiencing significant pain relief over an average of 28 months;61 Gross et al found good or excellent results in 78% of patients at 30 months 62…”