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

Etiology

As mentioned previously, focal chondral defects of the glenohumeral joint are rare and are often associated with other pathology or a traumatic event. Shoulder instability is the pathology most commonly linked to these chondral injuries. In a series of 87 shoulders (83 patients) treated with arthroscopy for glenohumeral instability, Krych et al[7] found cartilage injuries in 56 shoulders (64%). Glenoid chondral defects were significantly associated with previous closed reduction of a shoulder dislocation (P = 0.046) and the number of shoulder dislocations (P = 0.032). Furthermore, a greater number of dislocations was associated with higher-grade lesions of the glenohumeral joint (P < 0.001). Chondral lesions are also more common in patients with superior labrum anterior to posterior (SLAP) tears, with the most common location of the lesion being underneath the biceps tendon on the humerus and/or at the anterior half of the glenoid.[8]

Iatrogenic chondral injury and chondrolysis is well described, with a 13% incidence after shoulder arthroscopy.[4] Iatrogenic chondrolysis has been associated with postoperative intra-articular infusion of bupivacaine or lidocaine,[4,9] the use of nonabsorbable suture anchors, and the use of thermal devices.[10–12] Patients typically report a painful, stiff joint, and radiographic findings demonstrate joint space narrowing and subchondral cystic changes.[9] Surgeon awareness of postarthroscopic chondrolysis is important. However, this condition is often diffuse, involving both the humeral head and the glenoid; thus, the techniques described for the management of focal chondral defects may not be applicable.

Osteochondritis dissecans is another cause of chondral lesions. Osteochondritis dissecans lesions are much more common in the knee and ankle than in the glenohumeral joint, which accounts for only 0.6% of osteochondritis dissecans lesions among children and adolescents.[5] These lesions are typically found within the glenoid fossa in adolescents and young adults.[13–15] Lesions on the humeral head have also been described.[16,17] Typically, osteochondritis dissecans lesions result in shoulder pain after microtrauma in the general population or in throwing athletes.[13–15] Additional causes of glenohumeral chondral defects include high-impact trauma, osteonecrosis, infection, and inflammatory arthritides.[18]

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