Long-term Clinical Outcomes After Microfracture of the Glenohumeral Joint: Average 10-Year Follow-up

Wang, Kevin C.; Frank, Rachel M.; Cotter, Eric J.; Davey, Annabelle; Meyer, Maximilian A.; Hannon, Charles P.; Leroux, Timothy; Romeo, Anthony A.; Cole, Brian J.

doi:10.1177/0363546517750627

Cited by 32 publications

(53 citation statements)

References 38 publications

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“…The results of microfracture may be lasting as well. Wang et al 24 found an overall survival rate of 76.6% after microfracture, with an average of 10-year follow-up in 13 patients. The authors also reported statistically significant improvements in VAS, SST, and ASES, without any significant change from the short-term (mean, 2.3 years) to long-term (mean, 10.2 years) follow-up.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis

Hill

Singh

Astolfi

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The benefit of rotator cuff repair (RCR) in patients with concurrent osteoarthritic changes remains unclear. RCR has the theoretical potential to increase the compressive force across the glenohumeral joint, further exacerbating osteoarthritis pain. The purpose of this study is to investigate pain relief and patient-reported outcomes of patients undergoing simultaneous RCR and microfracture of focal glenohumeral osteoarthritis. Methods: Thirty-four patients undergoing simultaneous RCR and microfracture were retrospectively reviewed at a minimum 1-year follow-up. Patient demographics, preoperative range of motion, functional outcomes (visual analog scale [VAS], Single Assessment Numeric Evaluation [SANE], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], and Simple Shoulder Test [SST]), and operative metrics were recorded. The patients were then contacted to obtain postoperative functional outcome scores (VAS, SANE, ASES, and SST). Results: Twenty-seven patients (11 male/16 female [79%]) were evaluated at a mean follow-up of 25.8 months (range, 12-46). The average age at surgery was 64.9 years (range, 56-78). Chronic tears were more common than acute tears (57.7% vs. 42.3%). The majority of patients had a full rotator cuff tear (89%) involving a mean 1.7 AE 0.8 tendons (range, 1-3). Eighty-eight percent of the humeral lesions were Outerbridge 4 compared with 84% on the glenoid. The mean estimated involvement between the 2 groups with 38.4% AE 18.4% of the humeral head involved and 34.6% AE 18.4% of the glenoid involved. PRO scores improved postoperatively with a reduction in mean VAS (6.6-2.0, P < .01), SANE (33.8-79.8, P < .01), ASES (38.0-80.9, P < .01), and SST (3.07-9.70, P < .01) scores. Cumulatively, only 52% (14/27) of the patients improved, however, by the MCID for all collected PROs. Conclusions: Our results demonstrate modest improvements in postoperative pain and functional scores at a minimum of 1-year follow-up in a cohort of patients who have undergone RCR and glenohumeral microfracture. In cases of small focal lesions of full-thickness cartilage loss, RCR with microfracture is a reasonable treatment option; however, patients should be counseled on expectations accordingly.

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Section: Discussionmentioning

confidence: 99%

Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis

Hill

Singh

Astolfi

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…According to the literature, the mean glenoid defect size ranges from 1.12 to 2.73 cm 2 , whereas the mean humeral defect size ranges from 4.22 to 6.00 cm 2 (Table 2). 3,[13][14][15][16] The mean articular cartilage depth of the humerus has been reported to be 1.24 mm, ranging from approximately 1.3 mm centrally and thinning to less than 1 mm along the periphery, and the mean depth of the glenoid fossa has been reported to be 1.88 mm. 17 Regeneration of lost cartilage has been the ultimate goal for treatment of articular cartilage defects of the glenohumeral joint.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 This technique has shown good results for small lesions but may lead to fibrocartilage buildup, with limited efficacy for larger lesions and poor long-term results. 3,13,14,18 In an osteochondral autograft procedure, osteochondral autograft plugs consisting of bone and cartilage are harvested, often from the knee, are then transferred and applied onto the defect. 19,20 However, a common complication is harvest-site morbidity.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Safe Cartilage Harvesting Quantity in the Shoulder: A Cadaveric Study

O’Brien

Dzieza

Bruner

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the volume and yield of morselized cartilage that can be harvested from the shoulder for immediate reimplantation and repair. Methods A standard arthroscopic approach was used to harvest non–load-bearing cartilage from 5 cadaveric shoulder specimens. Cartilage was separated from the humerus, grasped, added to the cartilage particulator, and morselized to form a cartilage paste. The volume of reclaimed cartilage was measured and compared with average humeral and glenoid defects. Results The total yield of cartilage paste following tissue processing that was obtained from the 5 glenohumeral joints ranged from 1.0 mL to 2.4 mL with a mean volume of 1.9 ± 0.5 mL, yielding a theoretical 18.6 cm 2 ± 5.2 cm 2 of coverage with a 1-mm monolayer. Previously reported mean glenoid defect size ranges from 1.12 cm 2 to 2.73 cm 2 , while the mean humeral defect size ranges from 4.22 cm 2 to 6.00 cm 2 . Conclusions This study validated that through a single-stage surgical and processing technique it is possible to obtain a sufficient volume for re-implantable autologous morselized cartilage graft to address most glenohumeral articular cartilage defects. Clinical Relevance Chondrocyte grafts have been shown to be effective in cartilage repair. A single-site, single-staged procedure that uses a patient’s autologous shoulder cartilage from the same joint has the potential to reduce morbidity associated with multiple surgical sites, multistaged procedures, or nonautologous tissue in shoulder surgery.

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“…9,21,23 Microfracture has been reported to have 33% to 42% poor outcomes at midterm follow-up. 24 Osteochondral allograft has a graft failure rate of 22% at 5 years after surgery. 18…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability

et al. 2020

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Background: Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear. Hypothesis: We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as P < .05. Results: We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs ( P = .025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age ( P = .019) and 2 to 5 reported instability events ( P = .001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; P = .012), patients with 2 to 5 instability events (OR, 4.2; P = .033), and patients with more than 5 instability events (OR, 6.0; P = .011). Conclusion: Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.

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Long-term Clinical Outcomes After Microfracture of the Glenohumeral Joint: Average 10-Year Follow-up

Cited by 32 publications

References 38 publications

Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis

Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis

Assessment of Safe Cartilage Harvesting Quantity in the Shoulder: A Cadaveric Study

Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability

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