Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

Anthony Fiegen, Devin P. Leland, Christopher D. Bernard, Aaron Krych, Jonathan D. Barlow, Diane L. Dahm, Christopher L. Camp

Research output: Contribution to journalArticle

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Abstract

Objective: To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. Design: A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. Results: Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. Conclusions: In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. Level of Evidence: Level IV.

Original languageEnglish (US)
JournalCartilage
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Shoulder Joint
Cartilage
Articular Cartilage
Imaging techniques
Arthroplasty
Defects
Magnetic resonance
Prosthetics
Reoperation
Joints
Transplantation
Humeral Head
Stress Fractures
Chondrocytes
Elbow
Osteoarthritis
Meta-Analysis
Magnetic Resonance Imaging
Demography
Guidelines

Keywords

  • cartilage
  • glenohumeral
  • joint preservation
  • osteochondral

ASJC Scopus subject areas

  • Immunology and Allergy
  • Biomedical Engineering
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Articular Cartilage Defects of the Glenohumeral Joint : A Systematic Review of Treatment Options and Outcomes. / Fiegen, Anthony; Leland, Devin P.; Bernard, Christopher D.; Krych, Aaron; Barlow, Jonathan D.; Dahm, Diane L.; Camp, Christopher L.

In: Cartilage, 01.01.2019.

Research output: Contribution to journalArticle

Fiegen, Anthony ; Leland, Devin P. ; Bernard, Christopher D. ; Krych, Aaron ; Barlow, Jonathan D. ; Dahm, Diane L. ; Camp, Christopher L. / Articular Cartilage Defects of the Glenohumeral Joint : A Systematic Review of Treatment Options and Outcomes. In: Cartilage. 2019.
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