Management of Articular Cartilage Defects in the Glenohumeral Joint

Adam J. Seidl, MD; Matthew J. Kraeutler, MD

Disclosures

J Am Acad Orthop Surg. 2018;26(11):e230-e237. 

In This Article

Abstract and Introduction

Abstract

Articular cartilage defects are not often encountered in the glenohumeral joint. These lesions are typically found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. Diagnosis can be difficult; these defects are often found incidentally during arthroscopic or open surgical management of other pathology. Initial management of isolated glenohumeral chondral defects is nonsurgical and includes physical therapy and/or corticosteroid injections. If nonsurgical treatment is unsuccessful, patients may undergo surgery. Because these lesions occur infrequently, few studies have documented surgical techniques and outcomes. Surgical strategies include arthroscopic débridement, microfracture surgery, osteochondral autograft or allograft transplantation, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation.

Introduction

Numerous surgical options exist for the management of articular cartilage defects, including chondral repair, microfracture, osteochondral autograft transplantation, osteochondral allograft, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation. Positive clinical outcomes have been demonstrated with each of these surgical techniques, especially in the knee and ankle joints.[1,2] In the non–weight-bearing glenohumeral joint, focal chondral defects are encountered infrequently and are usually found in association with other pathologies, such as glenohumeral instability,[3] postoperative chondrolysis,[4] focal osteonecrosis, septic arthritis, osteochondritis dissecans,[5] and rotator cuff tears.[6] In a series of 200 shoulders with full-thickness rotator cuff tears (mean patient age, 56.1 years), Gartsman and Taverna[6] found full-thickness chondral lesions in seven humeral heads (average area, 250 mm2) and two glenoids (average area, 200 mm2). In a study of 101 patients with anterior shoulder instability and 64 control patients, glenoid chondral injuries were found on magnetic resonance arthrography in 46% of patients with Hill-Sachs defects and 21% of patients without Hill-Sachs defects.[3]

Here, we review the current literature on management of glenohumeral chondral defects and assign grades of treatment recommendations based on current evidence.

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