Management of cartilage defects in the shoulder

Abstract

Articular cartilage lesions of the glenohumeral joint are an especially difficult clinical problem to manage, particularly in the younger, more active patient. Left untreated, these lesions may progress in the long-term, leading to further pain and disability. While shoulder arthroplasty remains a viable option in older patients with glenohumeral arthritis, concerns over component longevity and loosening in younger patients make it less attractive in that age group. Arthroscopic joint debridement with loose body removal, often with capsular release, has been successful in select, more sedentary patients. More recent techniques, including autologous chondrocyte implantation (ACI), osteochondral grafting (allograft versus autograft), interpositional arthroplasty, and microfracture surgery, have been evaluated for use in the shoulder. These procedures have experienced success in weight bearing joints, including the knee and ankle. Despite the good clinical results in the shoulder with short-term follow-up reported in some small series, the treatment of chondral injuries in the glenohumeral joint remains a challenging problem.

Knorpelläsionen und Knorpeltherapie des Schultergelenks

“…Die klinische Diagnostik ist oft unspezifisch, da der Großteil der Patienten weitere Pathologien aufweist, die symptomatisch im Vordergrund stehen. Auch die radiologische Diagnostik vor allem umschriebener Knorpelschäden ist schwierig (9,15,25). Die hyaline Knorpelschicht des Humeruskopfes ist a priori mit ca.…”

Alternative options to traditional shoulder replacement

“…20 Such procedures can be performed using standard open techniques or arthroscopic methods. 20 Such procedures can be performed using standard open techniques or arthroscopic methods.…”

“…20 Capsular release followed by manipulation also may be an important part of the procedure to increase range of motion. The goal of palliative treatment is to provide pain relief and functional gains by removing damaged flaps of cartilage and loose bodies.…”

“…6,18,20,22 It was first described as a cartilage reparative strategy for the knee to stimulate fibrocartilage growth in a contained cartilage defect. 6,18,20,22 It was first described as a cartilage reparative strategy for the knee to stimulate fibrocartilage growth in a contained cartilage defect.…”

“…20 Studies evaluating the use of osteochondral autologous transplantation from the knee to treat chondral lesions of the humerus and glenoid have demonstrated radiographic evidence of progression of osteoarthritis; however, no patients required additional operative treatments. However, few reports describe similar techniques in the shoulder, and their place in the treatment of glenohumeral arthritis in young patients is not well defined.…”