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Dagher D, Selznick A, Prada C, Al Shehab Y, Leroux T, Khan M. Surgical treatment options for articular cartilage defects of the glenohumeral joint: A systematic review. Shoulder Elbow 2023; 15:580-592. [PMID: 38028932 PMCID: PMC10656978 DOI: 10.1177/17585732221142610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 12/01/2023]
Abstract
Background Many joint-preserving surgical interventions for cartilage defects of the knee have been adapted for use in the shoulder; however, there still exists no clear consensus for treatment. Thus, the purpose of this systematic review was to evaluate the outcomes of different interventions in patients with focal chondral lesions of the glenohumeral joint. Methods A literature search was conducted using PubMed, Embase, and Medline. Patients who underwent a joint-preserving surgical procedure to treat a focal chondral defect of the glenoid, humeral head or both were included. Patients treated for diffuse cartilage defects or with shoulder arthroplasty were excluded. Results Ten studies were included, with follow-up data available for 194 shoulders. Eight joint-preserving procedures were evaluated, with microfracture being the most common. One study evaluating microfracture reported significant improvements in patient-reported outcomes at short-term and long-term follow-up compared to preoperative scores. Across all studies, 32 patients underwent subsequent shoulder surgery, with 22 being arthroplasties. Conclusions We found improvements in patient-reported and functional outcomes across all studies. Although joint-preserving procedures have shown reasonable outcomes for focal chondral defects of the glenohumeral joint, long-term outcomes remain unknown, and the progression of osteoarthritis remains a concern. Higher quality evidence is required to make definitive recommendations. Level of Evidence IV.
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Affiliation(s)
- Danielle Dagher
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Asher Selznick
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Yasser Al Shehab
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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2
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Bedrin MD, Clark DM, Yow BG, Dickens JF, Kilcoyne KG. Favorable short-term outcomes of micronized allogenic cartilage scaffold for glenoid cartilage defects associated with posterior glenohumeral instability. Arthrosc Sports Med Rehabil 2023; 5:100809. [PMID: 37868657 PMCID: PMC10585635 DOI: 10.1016/j.asmr.2023.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/31/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To determine clinical outcomes associated with micronized allogenic cartilage scaffold use for treatment of posterior glenoid cartilage defects at 2 years. Study Design Case series. Methods A retrospective analysis of prospectively collected data was performed on a consecutive series of patients who underwent arthroscopic treatment of a symptomatic posterior glenoid cartilage defect with micronized allogenic cartilage scaffold between January 2019 and December 2020. The primary outcome was subjective shoulder value (SSV) at latest follow-up. Secondary outcomes included visual analog scale (VAS), recurrence of instability, and range of motion (ROM). Results Seven patients, including 4 in the setting of primary posterior instability and 3 in the setting of recurrent symptoms after arthroscopic posterior glenohumeral stabilization, were included in the analysis with a mean follow up of 2.6 years (range, 2-3.7 years). Statistically significant improvements were seen in SSV (median = 40, interquartile range [IQR] = 40-50 before surgery; vs median = 85, IQR = 67.5-87.5 after surgery; P = .018) and VAS (median = 4, IQR = 4-6.3 before surgery; vs median = 1, IQR = 0-1.5 after surgery; P = .010). No significant differences were seen in ROM. There were no cases of recurrent instability or reoperation. Conclusions The use of micronized allogenic cartilage scaffold for glenoid cartilage defects is associated with clinical improvement at 2-year follow-up. This is the case when performed in conjunction with index posterior labral repair when there is a concomitant glenoid cartilage defect or when performed in the setting of persistent pain and mechanical symptoms after prior posterior labral repair. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Michael D. Bedrin
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A
| | - DesRaj M. Clark
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A
| | - Bobby G. Yow
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A
| | - Jonathan F. Dickens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A
- Duke University, Department of Orthopaedics, Durham, North Carolina, U.S.A
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kelly G. Kilcoyne
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of Health Sciences, Bethesda, Maryland, U.S.A
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3
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Kaiser JT, Wagner KR, Menendez ME, Meeker ZD, Damodar D, Haunschild ED, Condron NB, Romeo AA, Yanke AB, Cole BJ. Long-term outcomes after osteochondral allograft transplantation to the humeral head. J Shoulder Elbow Surg 2023; 32:2310-2316. [PMID: 37245618 DOI: 10.1016/j.jse.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/28/2023] [Accepted: 04/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Long-term outcomes of osteochondral allograft (OCA) transplantation to the humeral head have been sparsely reported in the literature. PURPOSE To evaluate outcomes and survivorship of OCA transplantation to the humeral head in patients with osteochondral defects at a minimum of 10 years of follow-up. METHODS A registry of patients who underwent humeral head OCA transplantation between 2004 and 2012 was reviewed. Patients completed pre and postoperative surveys including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 12 (SF-12), and the visual analog scale. Failure was defined by conversion to shoulder arthroplasty. RESULTS Fifteen of 21 (71%) patients with a minimum of ten year of follow-up (mean: 14.2 ± 2.40) were identified. Mean patient age was 26.1 ± 8.8 years at the time of transplantation and eight (53%) patients were male. Surgery was performed on the dominant shoulder in 11 of the 15 (73%) cases. The use of local anesthetic delivered via an intra-articular pain pump was the most often reported underlying etiology of chondral injury (n = 9; 60%). Eight (53%) patients were treated with an allograft plug, while seven (47%) patients were treated with a mushroom cap allograft. At final follow-up, mean American Shoulder and Elbow Surgeons (49.9 to 81.1; P = .048) and Simple Shoulder Test (43.1 to 83.3; P = .010) significantly improved compared to baseline. Changes in mean SF-12 physical (41.4 to 48.1; P = .354), SF-12 mental (57.5 to 51.8; P = .354), and visual analog scale (4.0 to 2.8; P = .618) did not reach statistical significance. Eight (53%) patients required conversion to shoulder arthroplasty at an average of 4.8 ± 4.7 years (range: 0.6-13.2). Kaplan-Meier graft survival probabilities were 60% at 10 years and 41% at 15 years. CONCLUSION OCA transplantation to the humeral head can result in acceptable long-term function for patients with osteochondral defects. While patient-reported outcomes metrics were generally improved compared to baseline, OCA graft survival probabilities diminished with time. The findings from this study can be used to counsel future patients with significant glenohumeral cartilage injuries and set expectations about the potential for further surgery.
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Affiliation(s)
- Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Nolan B Condron
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | | | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA.
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4
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Hookway S, Alder-Price A, Gill SD, Mattin A, Page RS. Long-term clinical and radiological outcomes following arthroscopic microfracture of the glenohumeral joint for chondral defects. JSES Int 2023; 7:2440-2444. [PMID: 37969492 PMCID: PMC10638574 DOI: 10.1016/j.jseint.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The primary aim of this study was to evaluate mid- and long-term outcomes following microfracture in patients with glenohumeral chondral lesions. Methods This prospective cohort study assessed patients with shoulder pain who were treated with arthroscopic microfracture for full-thickness chondral lesions of the glenohumeral joint. Outcomes included the Simple Shoulder Test at baseline, mid-term (approximately 1 year) and long-term (approximately 10 years), and the Oxford Shoulder Score, shoulder pain (0-10 numerical scale) and radiological assessment using a modified Samilson & Prieto score at long-term follow-up. Data were analyzed with paired t-tests and Wilcoxon's signed rank tests, which were considered significant if P < .05. Results Twenty-five patients with a mean age of 52.7 ± 12.1 were enrolled. The mean Simple Shoulder Test score improved from baseline to 1 year (6.7 ± 2.5 to 11.0 ± 1.4, P < .001), which was maintained at long-term follow-up (10.3 ± 2.1, P < .001). Additionally, at long-term follow-up, Oxford Shoulder Score and Verbal Pain Score scores were 43 ± 4.8 and 1.1 ± 1.5, respectively while median modified Samilson & Prieto scores increased from 1 preoperatively to 2 at 10 years (P < .001). Conclusion Patients undergoing microfracture for full-thickness chondral lesions of the glenohumeral joint reported substantial improvements in shoulder pain and function at 1 and 10 years, despite progressive radiological degeneration.
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Affiliation(s)
- Sam Hookway
- Department of Orthopaedics, University Hospital Geelong, VIC, Australia
| | - Angela Alder-Price
- Department of Orthopaedics, University Hospital Geelong, VIC, Australia
- The University of Adelaide, School of Medicine, SA, Australia
| | - Stephen D. Gill
- Department of Orthopaedics, University Hospital Geelong, VIC, Australia
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Surgery, Barwon Centre for Orthopaedic Research & Education, St John of God Hospital Geelong, VIC, Australia
| | - Andrew Mattin
- Department of Surgery, Fiona Stanley Hospital, Perth, WA, Australia
| | - Richard S. Page
- Department of Orthopaedics, University Hospital Geelong, VIC, Australia
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Surgery, Barwon Centre for Orthopaedic Research & Education, St John of God Hospital Geelong, VIC, Australia
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5
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Green CK, Scanaliato JP, Sandler AB, Adler A, Dunn JC, Parnes N. Simultaneous Arthroscopic Rotator Cuff Repair and Glenoid Microfracture in Active-Duty Military Patients Younger Than 50 Years: Outcomes at Midterm Follow-up. Orthop J Sports Med 2023; 11:23259671231202282. [PMID: 37859753 PMCID: PMC10583522 DOI: 10.1177/23259671231202282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background While concomitant full-thickness rotator cuff tears and glenoid osteochondral defects are relatively uncommon in younger patients, military patients represent a unique opportunity to study this challenging injury pattern. Purpose/Hypothesis To compare the outcomes of young, active-duty military patients who underwent isolated arthroscopic rotator cuff repair (ARCR) with those who underwent ARCR plus concurrent glenoid microfracture (ARCR+Mfx). It was hypothesized that ARCR+Mfx would produce significant improvements in patient-reported outcome measures. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective analysis of consecutive active-duty military patients from a single base who underwent ARCR for full-thickness rotator cuff tears between January 2012 and December 2020. All patients were <50 years and had minimum 2-year follow-up data. Patients who underwent ARCR+Mfx were compared with those who underwent isolated ARCR based on the visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) shoulder score, and range of motion. Results A total of 88 patients met the inclusion criteria for this study: 28 underwent ARCR+Mfx and 60 underwent isolated ARCR. The mean final follow-up was 74.11 ± 33.57 months for the ARCR+Mfx group and 72.87 ± 11.46 months for the ARCR group (P = .80). There were no differences in baseline patient characteristics or preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all). However, the ARCR+Mfx group had significantly worse VAS pain (1.89 ± 2.22 vs 1.03 ± 1.70; P = .05), SANE (85.46 ± 12.99 vs 91.93 ± 12.26; P = .03), and ASES (86.25 ± 14.14 vs 92.85 ± 12.57; P = .03) scores. At the final follow-up, 20 (71.43%) patients in the ARCR+Mfx group and 53 (88.33%) patients in the ARCR group were able to remain on unrestricted active-duty military service (P = .05). Conclusion Concomitant ARCR+Mfx led to statistically and clinically significant improvements in patient-reported outcome measures at the midterm follow-up. However, patients who underwent ARCR+Mfx had significantly worse outcomes and were less likely to return to active-duty military service than those who underwent isolated ARCR. The study findings suggest that ARCR+Mfx may be a reasonable option for young, active patients who are not candidates for arthroplasty.
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Affiliation(s)
- Clare K. Green
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Adam Adler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
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6
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Green CK, Scanaliato JP, Sandler AB, Dunn JC, Covillon E, Parnes N. Simultaneous Arthroscopic Glenohumeral Stabilization and Glenoid Microfracture in Young, Active-Duty Military Patients: Outcomes at 5-Year Follow-up. Orthop J Sports Med 2023; 11:23259671221146170. [PMID: 36756169 PMCID: PMC9900666 DOI: 10.1177/23259671221146170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background Glenohumeral instability represents a common cause of shoulder pain and disability among active-duty members of the military and is associated with the development of glenoid osteochondral defects. Purpose To report clinical outcomes and survivorship after combined microfracture of isolated chondral lesions of the glenoid and labral repair among young, active-duty military patients and to compare outcomes with those of patients who underwent isolated shoulder stabilization. Study Design Cohort study; Level of evidence, 3. Methods Included were 31 active-duty military patients aged <40 years who underwent simultaneous microfracture of chondral lesions of the glenoid and labral repair for shoulder instability between January 2011 and January 2017 (microfracture group) and 209 patients without chondral defects who underwent shoulder stabilization during the same time period (instability group). Preoperative and 5-year postoperative outcomes (range of motion [ROM], visual analog scale [VAS] for pain, Single Assessment Numeric Evaluation [SANE] score, American Shoulder and Elbow Surgeons [ASES] shoulder score, and Rowe instability score) were compared within and between groups, and separate subgroup analyses were performed to determine whether variant of instability and dominant-shoulder involvement were associated with worse outcomes. Results The mean follow-up was significantly longer for the microfracture group versus the instability group (95.58 ± 23.12 vs 83.38 ± 25.93 months; P = .014). Age and sex distributions were similar between groups. In both groups, there was significant pre- to postoperative improvement on all outcomes scores (P = .0001 for all). When compared with the instability cohort, microfracture patients had significantly worse postoperative VAS pain (2.65 ± 1.78 vs 1.55 ± 1.92; P = .003), SANE (79.13 ± 14.43 vs 91.23 ± 13.20; P < .0001), and ASES (79.90 ± 13.87 vs 89.03 ± 14.28; P = .001) scores, as well as decreased ROM in forward flexion (151.29° ± 11.76° vs 155.48° ± 10.3°; P = .039) and external rotation (63.65° ± 8.34° vs 65.17° ± 0.64°; P = .010). At latest follow-up, 58% of microfracture patients had returned to active-duty military service compared with 93.78% of isolated instability patients (P < .0001). Conclusion Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient-reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty. However, microfracture patients had significantly worse outcomes than patients who underwent stabilization without concomitant chondral defects.
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Affiliation(s)
- Clare K. Green
- George Washington University School of Medicine, Washington DC,
USA.,Clare K. Green, BS, George Washington University School of
Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052, USA
()
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical
Center, El Paso, Texas, USA.,Department of Orthopaedic Surgery, Texas Tech University Health
Sciences Center, El Paso, Texas, USA
| | - Alexis B. Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical
Center, El Paso, Texas, USA.,Department of Orthopaedic Surgery, Texas Tech University Health
Sciences Center, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical
Center, El Paso, Texas, USA.,Department of Orthopaedic Surgery, Texas Tech University Health
Sciences Center, El Paso, Texas, USA
| | - Emma Covillon
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage,
New York, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage,
New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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7
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Woodard DR, Hutton JD, Phipatanakul WP, Syed HM. Whole humeral head osteochondral allograft with glenoid bone block augmentation after chronic locked bilateral anterior shoulder dislocations in an adolescent patient: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:384-390. [PMID: 37588871 PMCID: PMC10426693 DOI: 10.1016/j.xrrt.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- David R. Woodard
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Wesley P. Phipatanakul
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Hasan M. Syed
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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8
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Kerzner B, Mehta N, Khan ZA, Bonadiman JA, Damodar D, Dasari SP, Fortier LM, Verma NN. Humeral Head Resurfacing for Isolated Primary Humeral Osteoarthritis With a Large Chondral Defect. Arthrosc Tech 2022; 11:e1223-e1231. [PMID: 35936842 PMCID: PMC9353195 DOI: 10.1016/j.eats.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023] Open
Abstract
Primary, isolated humeral head arthritis or focal chondral defects are uncommon and difficult to diagnose preoperatively. While these lesions have traditionally been treated with total shoulder arthroplasty, shoulder hemiarthroplasty is a viable option for patients with isolated humeral head disease and minimal degenerative changes in the glenoid. This approach can be performed in a minimally invasive fashion, which preserves bone stock and native biomechanics, and can be beneficial if conversion to total shoulder arthroplasty is required in the future and avoids risk of glenoid loosening or failure in younger and more active individuals. In this Technical Note and accompanying video, we describe our technique of humeral head resurfacing in a patient with isolated primary humeral osteoarthritis with a large focal chondral defect in the humeral head.
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Affiliation(s)
- Benjamin Kerzner
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.,Address correspondence to: Benjamin Kerzner, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL 60612.
| | - Nabil Mehta
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - João A. Bonadiman
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Suhas P. Dasari
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luc M. Fortier
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Midwest Orthopaedics at Rush and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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9
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Lacheta L, Braun S. Limited evidence for biological treatment measures for cartilage and tendon injuries of the shoulder. Knee Surg Sports Traumatol Arthrosc 2022; 30:1132-1137. [PMID: 33609150 DOI: 10.1007/s00167-021-06499-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To critically review the available literature on the usage of biologics to treat cartilage and tendon injuries of the shoulder. METHODS Four different databases were searched in January 2020 for studies reporting data on bone marrow stimulation, autologous chondrocyte implantation, platelet-rich plasma, autologous concentrated serum, and bone marrow aspirate concentrate for the treatment of cartilage and/or tendon injuries of the shoulder. Prospective, retrospective, cohort and case-control studies as well as case series, systematic reviews and laboratory studies (involving human tissue) were included. Cadaveric or animal studies were excluded. Findings were summarized and an expert opinion on trends was provided. RESULTS Although there is limited literature available on biologics in cartilage lesions of the shoulder, the advancement from micro- to nanofracture, that is well established for the treatment of cartilage lesions in the knee, may be the next step in the treatment of shoulder lesions as well. The high rate of failure and therefore the complexity of tendon healing following rotator cuff repair has led to a rising interest in biologic augmentation such as platelet-rich plasma and stem cells to enhance tendon-bone-healing and to decrease the prevalence of failure. Despite the increase in publications, there exists a huge heterogeneity of content, quality, and quantity of among studies and their processing methods reporting the use of platelet-rich plasma in rotator cuff repair. CONCLUSION Conclusions from individual studies cannot be generalized. Currently, no evidence supports that platelet-rich plasma provides clinical benefits in rotator cuff repair. Similar is reported for microfracture in rotator cuff repair, however, despite no clinical benefits, microfracture has shown to reduce the appearance of structural failures. Although some evidence exists for the use of stem cells form bone marrow aspirate concentrate, results from large case series are still lacking. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Lucca Lacheta
- Center for Musculosceletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Sepp Braun
- Gelenkpunkt, Sports and Joint Surgery Innsbruck, Innsbruck, Austria. .,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Medical Informatics and Technology, University for Health Sciences, Hall, Austria.
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10
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Fiegen A, Leland DP, Bernard CD, Krych AJ, Barlow JD, Dahm DL, Camp CL. Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes. Cartilage 2021; 13:401S-413S. [PMID: 31441316 PMCID: PMC8808793 DOI: 10.1177/1947603519870858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
| | | | | | | | | | | | - Christopher L. Camp
- Mayo Clinic, Rochester, MN, USA,Christopher L. Camp, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Wermers J, Schliemann B, Raschke MJ, Dyrna F, Heilmann LF, Michel PA, Katthagen JC. The Glenolabral Articular Disruption Lesion Is a Biomechanical Risk Factor for Recurrent Shoulder Instability. Arthrosc Sports Med Rehabil 2021; 3:e1803-e1810. [PMID: 34977634 PMCID: PMC8689271 DOI: 10.1016/j.asmr.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the biomechanical effect of a glenolabral articular disruption (GLAD) lesion on glenohumeral laxity. Methods Human cadaveric glenoids (n = 10) were excised of soft tissue, including the labrum to focus on the biomechanical effects of osteochondral surfaces. Glenohumeral dislocations were performed in a robotic test setup, while displacement forces and three-dimensional morphometric properties were measured. The stability ratio (SR), a biomechanical characteristic for glenohumeral stability, was used as an outcome parameter, as well as the path of least resistance, determined by a hybrid robot displacement. The impacts of chondral and bony defects were analyzed related to the intact glenoid. Statistical comparison of the defect states on SR and the path of least resistance was performed using repeated-measures ANOVA and Tukey’s post hoc test for multiple comparisons (P < .05). The relationship between concavity depth and SR was approximated in a nonlinear regression. Results The initial SR of the intact glenoid (28.3 ± 7.8%) decreased significantly by 4.7 ± 3% in case of a chondral defect (P = .002). An additional loss of 3.2 ± 2.3% was provoked by a 20% bony defect (P = .004). The path of least resistance was deflected significantly more inferiorly by a GLAD lesion (2.9 ± 1.8°, P = .002) and even more by a bony defect (2.5 ± 2.9°, P = .002). The nonlinear regression with concavity depth as predictor for the SR resulted in a high correlation coefficient (r = .81). Conclusions Chondral integrity is an important contributor to the SR. Chondral defects as present in GLAD lesions may cause increased laxity, influence the humeral track on the glenoid during dislocation, and represent a biomechanical risk factor for a recurrent instability. Clinical Relevance Cartilage deficiency corresponding to GLAD lesions may be a risk factor for impaired surgical outcomes.
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Affiliation(s)
- Jens Wermers
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Benedikt Schliemann
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Michael J Raschke
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Felix Dyrna
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Lukas F Heilmann
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Philipp A Michel
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - J Christoph Katthagen
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
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Arthroscopic management of glenohumeral arthritis in the young patient does not negatively impact the outcome of subsequent anatomic shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:2071-2079. [PMID: 34255098 DOI: 10.1007/s00264-021-05133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this study was to determine the impact of prior arthroscopic management of glenohumeral arthritis in the young patient on results of subsequent anatomic shoulder arthroplasty. METHODS Forty-three patients that had a total shoulder or ream-and-run arthroplasty with a history of arthroscopic management were matched to 86 patients without prior surgery. Each case was matched to two cases without prior arthroscopic surgery with similar age, sex, Walch classification, and type of arthroplasty. RESULTS Forty-three patients with a history of arthroscopic management were matched to 86 patients without prior surgery. The mean two year SST scores (10.3 vs. 9.9, p = 0.334), % MPI (75.4 vs. 73.0%, p = 0.687), two year SANE scores (79.6 vs. 79.8, p = 0.953), and % of patients to exceed SST score MCID (89 vs. 91%, p = 0.860) and SANE score MCID (86 vs. 75%, p = 0.180) were statistically similar in patients with prior arthroscopic debridement compared with those without prior arthroscopic debridement. The rate of MUA (9 vs. 6%, p = 0.480) and open revision (9 vs. 8%, p = 1.000) were statistically similar between groups. CONCLUSION Arthroscopic management of glenohumeral arthritis in patients aged 65 years and younger prior to anatomic shoulder arthroplasty was not associated with inferior outcomes for either total shoulder arthroplasty or ream-and-run arthroplasty.
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Wright-Chisem J, Apostolakos JM, Dines JS, Dines DM, Gulotta LV, Taylor SA, Werner BC. The impact of prior ipsilateral arthroscopy on infection rates after shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:1596-1602. [PMID: 33069904 DOI: 10.1016/j.jse.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients frequently undergo interventions before shoulder arthroplasty, including injections and arthroscopy. Although the potential impact of injections on postoperative outcomes such as infection has been well studied, it is less clear whether prior arthroscopy has an impact on infection rates after shoulder arthroplasty. The purpose of this study was to determine whether prior ipsilateral shoulder arthroscopy is associated with an increased risk of postoperative infection after shoulder arthroplasty. METHODS Patients who underwent shoulder arthroplasty, including hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty with a minimum of 1-year preoperative database exposure, were queried using Current Procedural Terminology codes from 2 large insurance databases, including both private-payer (Humana, 2008-2017) and Medicare (2006-2014) data. Patients with procedures for infection, fractures, or without laterality data were excluded. Those who underwent ipsilateral shoulder arthroscopy within 2 years before their arthroplasty were identified and compared with controls who did not undergo prior arthroscopy. Each database was analyzed separately. Periprosthetic infection within 1 year after arthroplasty was queried for each group and compared using a logistic regression analysis with control for demographic and comorbidity confounders. RESULTS A total of 9362 Medicare patients and 17,716 private-payer patients were included in the study. Of these, 486 (5.2%) Medicare patients and 685 (3.9%) private-payer patients underwent prior arthroscopy. In the Medicare database, prior arthroscopy was also associated with a postarthroplasty infection rate of 3.9% as compared with 1.9% in the control group (odds ratio: 1.96, 95% confidence interval: 1.20-3.22, P = .003). Similarly, in the private insurance cohort, prior shoulder arthroscopy was associated with a postarthroplasty infection rate of 2.9% as compared with 1.4% in the control group (odds ratio: 1.85, 95% confidence interval: 1.13-3.03, P = .005). CONCLUSION Shoulder arthroscopy performed within 2 years before shoulder arthroplasty is associated with a higher infection rate in the first year after shoulder arthroplasty.
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Affiliation(s)
- Joshua Wright-Chisem
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John M Apostolakos
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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Lorenz CJ, Freislederer F, Salzmann GM, Scheibel M. Minced Cartilage Procedure for One-Stage Arthroscopic Repair of Chondral Defects at the Glenohumeral Joint. Arthrosc Tech 2021; 10:e1677-e1684. [PMID: 34354912 PMCID: PMC8322290 DOI: 10.1016/j.eats.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023] Open
Abstract
Chondral defects of the glenohumeral joint are common but still remain a diagnostic and management challenge. Whereas arthroplasty is a reasonable treatment option in the elderly and low-demand population, joint preservation should be aimed for the remaining patients. For larger defects the current gold standard of treatment is autologous chondrocyte implantation. However, disadvantages such as high cost, the restriction in availability of specialized laboratories, and the 2-stage surgical design need to be accounted for if choosing this option. Showing first good clinical results for the knee joint, minced cartilage implantation is moreover a cost-effective procedure bringing autologous cartilage chips harvested from the defect walls and bringing them into the area of damage in a single-step open or arthroscopic approach. We describe an arthroscopic strategy of this technique to treat chondral defects at the glenohumeral joint.
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Affiliation(s)
| | | | | | - Markus Scheibel
- Schulthess Clinic, Zurich, Switzerland,Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany,Address correspondence to Markus Scheibel, M.D., Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland.
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Hinz M, Imhoff AB, Schmitt A. [Update on the Operative Treatment of Cartilage Defects]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 159:459-475. [PMID: 33975378 DOI: 10.1055/a-1302-8636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Focal cartilage defects lead to swelling, significant pain and loss of function of the affected joint. Additionally, they are linked to early onset of osteoarthritis. Often young and active patients are especially susceptible due to the high stress placed on their joints. A vast amount of treatment options is available to orthopaedic surgeons to cure cartilage defects of the knee, hip, shoulder, elbow and ankle joints. This article serves to give an overview of these available treatment options and to explain the expected outcomes.
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Porcellini G, Cecere AB, Giorgini A, Micheloni GM, Tarallo L. The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020020. [PMID: 33559615 PMCID: PMC7944697 DOI: 10.23750/abm.v91i14-s.10987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a starting point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. METHODS A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: "GlenoLabral Articular Disruption" OR "GLAD" AND "shoulder" AND "cartilage, articular". RESULTS Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of glenohumeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. CONCLUSIONS The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser's original definition described stable shoulders following a trauma in adduction.
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Affiliation(s)
- Giuseppe Porcellini
- 1 Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Antonio Benedetto Cecere
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Naples, Italy.
| | - Andrea Giorgini
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | | | - Luigi Tarallo
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
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Franz A, Bittersohl B, Beitzel K. Biologische Knorpelersatztherapieverfahren an der Schulter. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Frank JK, Heuberer PR, Laky B, Anderl W, Pauzenberger L. Glenohumeral Microfracturing of Contained Glenohumeral Defects: Mid- to Long-term Outcome. Arthrosc Sports Med Rehabil 2020; 2:e341-e346. [PMID: 32875298 PMCID: PMC7451850 DOI: 10.1016/j.asmr.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/29/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose To report mid- to long-term clinical and radiological outcomes after microfracturing for symptomatic chondral defects of the glenohumeral joint. Methods All patients who underwent glenohumeral arthroscopic microfracturing between 2002 and 2012 at a single center were considered for inclusion in this retrospective study. Clinical outcome was evaluated using the Constant Score, Oxford Shoulder Score, and Subjective Shoulder Value. Progression of joint space narrowing, sclerosis, marginal osteophytes, and presence of cysts over time were assessed using 4 different radiological grading systems. Results A total of 16 patients (n = 9 female, n = 7 male) with a mean age of 51.8 ± 12.6 years at the time of surgery and a mean follow-up of 122 ± 51.2 months (range, 61-204 months) were included in this retrospective study. Nine patients (56.3%) showed an isolated chondral defect, while 7 patients (43.8%) had concomitant pathologies. Constant Score (60.3 ± 12.7 vs. 85.9 ± 9.3; P < .001), Oxford Shoulder Score (29.0 ± 5.8 vs. 42.4 ± 4.5; P < .001), and Subjective Shoulder Value (23.9 ± 7.4 vs. 84.3 ± 10.9; P < .001) changed significantly from pre- to postoperative. The majority of patients (88%) were able to return to their preoperative level of activity. Three patients (19.8%) developed radiological signs of progressive glenohumeral degeneration during the study period. However, only 1 patient (6.25%) showed a progression of arthritic changes of more than 1 grade according to radiographic classifications. Two patients (12.5%) underwent revision surgery to a hemi shoulder arthroplasty during the study period at 12 and 36 months after the initial procedure. Conclusions Glenohumeral microfracturing is commonly performed together with other procedures, but seems to be a feasible treatment option for contained cartilage lesions in active patients reproducibly yielding good mid- to long-term outcome. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | - Philipp R Heuberer
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Brenda Laky
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Werner Anderl
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
| | - Leo Pauzenberger
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Sports Surgery Clinic, Dublin, Ireland
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19
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Williams BT, Beletsky A, Kunze KN, Polce EM, Cole BJ, Verma NN, Chahla J. Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review. Arthroscopy 2020; 36:2010-2021. [PMID: 32151663 DOI: 10.1016/j.arthro.2020.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of the literature describing outcomes, surgical procedures, and rates of conversion to arthroplasty after arthroscopic debridement of symptomatic primary glenohumeral osteoarthritis. METHODS The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and Ovid MEDLINE were queried. Articles without sufficiently detailed descriptions of the debridement procedure, those primarily describing cartilage resurfacing procedures, or those that did not report any postoperative outcomes were excluded. Study design, patient demographic characteristics, operative details, imaging findings, patient-reported outcomes, and rates of conversion to arthroplasty were compiled and reported. Assessment of bias was performed using the Methodological Index for Non-randomized Studies (MINORS) criteria. RESULTS A total of 371 patients (382 shoulders) in 8 studies were included. Patient sample sizes ranged from 8 patients (9 shoulders) to 98 patients (107 shoulders), and the samples were predominantly comprised of male patients (range, 57.1%-100%). The mean age and follow-up period ranged from 38 to 59 years and from 13.7 to 46.8 months, respectively. In studies reporting both preoperative and postoperative outcomes, improvements were found in American Shoulder and Elbow Surgeons scores (range, 8.6-22) and visual analog scale scores for pain (range, 0.4-3.8). There was significant heterogeneity (I2 = 75%) in the rates of conversion to shoulder arthroplasty, which ranged from 4% to 42.4%, with the mean time to conversion ranging from 9 to 56 months. Study heterogeneity improved with subgroup analyses based on minimum duration of follow-up (>2 years) and preoperative radiographic inclusion criteria. CONCLUSIONS Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. Despite variability in procedures and rates of subsequent conversion to arthroplasty, arthroscopic treatment appears to provide symptom relief and functional improvements in carefully selected patients. However, the longevity of improvement remains unclear, with studies including a longer duration of follow-up showing potential regression of symptom relief and increased rates of conversion to arthroplasty. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Brady T Williams
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Alexander Beletsky
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kyle N Kunze
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Evan M Polce
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
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20
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Boehm E, Minkus M, Scheibel M. Autologous chondrocyte implantation for treatment of focal articular cartilage defects of the humeral head. J Shoulder Elbow Surg 2020; 29:2-11. [PMID: 31547946 DOI: 10.1016/j.jse.2019.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) constitutes an established treatment option for cartilage defects of the knee joint. Experience in the shoulder, however, is limited, and the management of cartilage defects remains a challenge. The purpose of this study was to evaluate the results after ACI with 3-dimensional spheroids of human autologous matrix-associated chondrocytes in the shoulder. METHODS Seven male patients (median age, 42.8 years [range, 18-55 years]) underwent ACI for symptomatic focal grade IV cartilage lesions of the humeral head by an open or arthroscopic approach. Clinical parameters (range of motion, visual analog scale score, Subjective Shoulder Value, Constant score, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score) and osteoarthritis grades were assessed. Arthroscopic re-evaluation was additionally performed in 5 patients. RESULTS After a median follow-up period of 32 months (range, 22-58 months), the median Subjective Shoulder Value was 95% (range, 70%-100%) compared with 60% (range, 30%-60%) preoperatively, the visual analog scale score was 0 at rest and was a median of 0 (range, 0-2) during exercise, the median Constant score was 95 points (range, 80-100 points), and the median American Shoulder and Elbow Surgeons score was 97 points (range, 90-100 points). The median preoperative size of the cartilage lesion was 3 cm2 (range, 2.3-4.5 cm2). Arthroscopically, complete coverage of the cartilage defect was observed in 4 cases whereas a circumferential residual defect of 0.25 cm2 was found in 1 patient. Grade I osteoarthritis (Samilson and Prieto classification) was observed in 2 cases. One patient had postoperative adhesive capsulitis and required revision surgery. CONCLUSION ACI using 3-dimensional spheroids of human autologous matrix-associated chondrocytes for treatment of grade IV articular cartilage lesions of the humeral head achieves satisfactory clinical results during a short- to mid-term follow-up period and leads to successful defect coverage with only minor radiologic degenerative changes. In this case series, ACI proved to constitute a viable treatment in the shoulder joint. However, in consideration of the 2-stage surgical design and the cost intensiveness of this procedure, the indication is restricted to young and active symptomatic patients in our practice.
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Affiliation(s)
- Elisabeth Boehm
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Marvin Minkus
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.
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21
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Chen G, Chen P, You T, Jiang X, Li W, Jiang C. Allogenic Tendon-Autologous Cartilage Cells Transplantation Enhances Adhesive/Growth Ability and Promotes Chondrogenesis in a Rabbit Model of Glenoid Labrum Damage. Ann Transplant 2019; 24:532-540. [PMID: 31527567 PMCID: PMC6765340 DOI: 10.12659/aot.917518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Glenoid labrum injury of the shoulder commonly occurs in athletes, especially those who perform throwing motions. This study investigated the effects of the established allogenic tendon-autologous cartilage cells reconstruction approach in a rabbit model of glenoid labrum damage. Material/Methods The allogenic tendons were isolated and extracted using the chemical extraction method. Cartilage cells were isolated from New Zealand rabbits and identified by detecting type II collagenase. The allogenic tendon-autologous cartilage cells were transplanted to the damaged glenoid labrum. HE staining was used to observe inflammatory cells, Masson staining was used to observe muscle fibers, and scanning electron microscopy (SEM) was used to assess antigenicity of tendon tissues. PSA and AB staining were used to examine neutral protein mucopolysaccharide and acidic protein mucopolysaccharide, respectively. We assessed cartilage cell growth in autologous cartilage cells combined with allogenic tendon transplanted tissues. Results Allogenic tendons were well prepared using chemical extraction method due to use of HE staining, Masson staining, and SEM. TGF-β1 treatment induced cartilage cell formation and triggered expression of acidic and neutral protein mucopolysaccharides. HE staining, Masson staining, PAS staining, and AB staining methods showed that autologous cartilage cells combined with allogenic tendon transplanted tissues had better growth of cartilage cells. Conclusions This study establishes the allogenic tendon-autologous cartilage cells reconstruction and transplantation approach and illustrated higher adhesive ability and growth ability, and better chondrogenesis in a rabbit model of glenoid labrum damage.
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Affiliation(s)
- Guofei Chen
- Department of Traumatic Arthrosis Orthopaedics, University of Chinese Academy of Sciences-Shenzhen Hospital Shenzhen, Shenzhen, Guangdong, China (mainland)
| | - Peng Chen
- Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Tian You
- Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Xiaocheng Jiang
- Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Wei Li
- Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Changqing Jiang
- Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
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Concurrent Primary Repair of a Glenoid Labrum Articular Disruption and a Bankart Lesion in an Adolescent: A Case Report of a Novel Technique. Case Rep Orthop 2019; 2019:4371860. [PMID: 30881714 PMCID: PMC6387695 DOI: 10.1155/2019/4371860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/31/2019] [Indexed: 12/22/2022] Open
Abstract
Glenoid labrum articular disruption (GLAD) lesions are an uncommon concomitant injury associated with labral tears, occurring in 1.5-2.9% of cases. In previous reported cases, the articular lesion is debrided during repair of the labral injury, which may predispose patients to osteoarthritis, a longitudinal complication seen in articular debridement of the hip. We report the case of a 15-year-old healthy adolescent male swimmer who sustained a labral injury with a concomitant GLAD lesion. During operative management, three Polyetheretherketone (PEEK) SutureTaks were placed on the glenoid. #2 FiberWire was used to imbricate capsular tissue, passed beneath the labrum, and was then subsequently advanced through the fibrous rim of the displaced cartilage flap/GLAD lesion at the site of each suture anchor. This construct restored tension to the anterior band of the inferior glenohumeral ligament, recreated the anteroinferior labral bumper, and effectively reduced the cartilage flap/GLAD lesion to the anterior inferior glenoid. By six months postoperatively, the patient demonstrated near-normal function with full range of motion and evidence of a stable construct on MRI. Unlike previously described cases, this is the first report of a hybrid technique that simultaneously performed a primary repair of both labral and articular injuries without the use of additional implants for the articular lesion. Primary repair of the labral and articular lesions should provide longitudinal benefit to the patient by reducing the risk of developing glenohumeral osteoarthritis.
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Arthroscopic autologous chondrocyte implantation in the glenohumeral joint: a case report. J Shoulder Elbow Surg 2018; 27:e300-e307. [PMID: 30120029 DOI: 10.1016/j.jse.2018.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 02/01/2023]
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Abstract
Glenohumeral osteoarthritis in the young patient (aged <60 years) is a difficult condition, given both age and functional demands. Primary osteoarthritis is the most common etiology in this patient demographic, but secondary causes include osteonecrosis, previous trauma (eg, fracture-dislocation), previous infection (eg, septic arthritis), previous capsulorrhaphy, previous arthroscopic surgery (eg, chondrolysis), and glenoid dysplasia. Nonsurgical modalities, including activity modification, pharmacotherapy, physical therapy, and intra-articular injections, are the mainstay of management; however, in young patients who have exhausted nonsurgical management, surgical options include arthroscopic débridement, humeral head replacement with or without glenoid treatment (ie, biologic glenoid resurfacing, glenoid reaming), and total or reverse total shoulder arthroplasty. Unfortunately, failure rates after surgical management are considerably higher in young patients compared with those observed in older, more sedentary patients. Here, we focus on the etiology, evaluation, and management of young patients with glenohumeral osteoarthritis, with a focus on clinical outcomes.
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Abstract
Articular cartilage injuries in the glenohumeral joint present a unique and difficult problem for the patient and surgeon alike. Various etiologies exist for the development of these cartilage lesions; therefore, treatment options are vast and must be chosen thoughtfully, especially in the young, active patient. Across all treatment modalities, the goal is for the patient to regain lasting function and mobility while decreasing pain.
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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.
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Pastor MF, Smith T, Wellmann M. [Options in joint-preserving surgical treatment of osteoarthritis]. DER ORTHOPADE 2018; 47:377-382. [PMID: 29508008 DOI: 10.1007/s00132-018-3541-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The treatment of glenohumeral arthritis represents a major challenge in highly active younger patients. In these patients, an endoprosthetic treatment often achieves only unsatisfactory results with a limited lifetime of the implant. OBJECTIVES The aim of the study was to identify joint-preserving therapies for glenohumeral arthritis. MATERIALS AND METHODS For this study, an extensive and selective literature search was performed. RESULTS There are several options available for joint-preserving treatment of glenohumeral arthritis. In addition to arthroscopic debridement with treatment of concomitant pathologies, CAM procedures (CAM: comprehensive arthroscopic management) according to Millett, as well as the interposition of allografts are other options. For all therapy options, an improved range of motion and pain reduction is described. A joint gap of <2 mm, bipolar cartilage lesions and age are described as risk factors for failure of the therapies. DISCUSSION Short and mid-term results have been described for arthroscopic debridement, but there are no long-term and high-quality studies to enable us to make clear recommendations. The CAM procedure and the interposition of an allograft are demanding procedures that should be reserved for experienced arthroscopists. The therapies are an option for younger patients in accordance with individual decisions and realistic expectations.
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Affiliation(s)
- Marc-Frederic Pastor
- Orthopädische Klinik, Medizinische Hochschule Hannover im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - Tomas Smith
- Orthopädische Klinik, Medizinische Hochschule Hannover im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - Mathias Wellmann
- Orthopädische Klinik, Medizinische Hochschule Hannover im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
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Wang KC, Frank RM, Cotter EJ, Davey A, Meyer MA, Hannon CP, Leroux T, Romeo AA, Cole BJ. Long-term Clinical Outcomes After Microfracture of the Glenohumeral Joint: Average 10-Year Follow-up. Am J Sports Med 2018; 46:786-794. [PMID: 29373801 DOI: 10.1177/0363546517750627] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Microfracture is an effective surgical treatment for full-thickness cartilage defects of the knee; however, little is known regarding long-term outcomes after microfracture in the shoulder. PURPOSE To present long-term clinical outcomes of patients undergoing microfracture of full-thickness articular cartilage defects of the glenohumeral joint. STUDY DESIGN Case series; Level of evidence, 4. METHODS Sixteen consecutive patients (17 shoulders) were retrospectively reviewed who underwent arthroscopic microfracture of the humeral head and/or glenoid surface, with or without additional procedures between 2001 and 2008 and with a minimum follow-up of 8.5 years. All patients completed pre- and postoperative surveys containing the visual analog scale, American Shoulder and Elbow Surgeons form, and Simple Shoulder Test. Complications and reoperations were analyzed. Failure was defined by biological resurfacing or conversion to arthroplasty. RESULTS Of the original 16 patients (17 shoulders), 13 patients (14 shoulders) were available for mean follow-up at 10.2 ± 1.8 years after microfracture (range, 8.5-15.8 years), for an overall clinical follow-up rate of 82%. The patients (6 men, 7 women) were 36.1 ± 12.9 years old at time of microfracture. The average size of humeral head defects was 5.20 cm2 (range, 4.0-7.84 cm2), and the average size of glenoid defects was 1.53 cm2 (range, 1.0-3.75 cm2). Four patients (4 shoulders) underwent at least 1 reoperation, and 3 were considered to have structural failures. The average time to failure was 3.7 years after microfracture (range, 0.2-9.6 years). The overall survival rate was 76.6% at 9.6 years. For these patients, there were statistically significant improvements in visual analog scale, Simple Shoulder Test, and American Shoulder and Elbow Surgeons scores as compared with preoperative values at long-term follow-up ( P < .05 for all), without any significant change from short-term (mean, 2.3 years) to long-term (mean, 10.2 years) follow-up. There was no significant difference in Single Assessment Numeric Evaluation or Short Form-12 Physical or Mental scores between short- and long-term follow-up. When compared with short-term follow-up, in which 2 patients had already failed, 1 additional patient progressed to failure at 9.6 years after the original microfracture. Two patients (2 shoulders) were considered to have clinical failure. Owing to the overall number of failures (3 structural failure and 2 clinical failure), the total long-term success rate of glenohumeral microfracture is 66.7% in the current study. CONCLUSION Treating full-thickness symptomatic chondral defects of the glenohumeral joint with microfracture can result in long-term improved function and reduced pain for some patients. However, in this case series, 21.4% of patients required conversion to arthroplasty <10 years after the index microfracture procedure, and 33% to 42% of patients were considered to have potential clinical failure. Additional studies with larger patient cohorts are needed.
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Affiliation(s)
- Kevin C Wang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Eric J Cotter
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Annabelle Davey
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Maximilian A Meyer
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Charles P Hannon
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Leroux
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anthony A Romeo
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, USA
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Bouaicha S. [Shoulder cartilage regeneration : Indications, possibilities, surgical implementation]. DER ORTHOPADE 2017; 46:914-918. [PMID: 28983649 DOI: 10.1007/s00132-017-3477-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Asymptomatic cartilage lesions of the shoulder are frequent. Symptomatic lesions are treated analogously to other hyaline cartilage bearing joints and can be treated arthroscopically in the vast majority of cases. The therapeutic options can be subdivided into resection, stimulation and transplantation of the defect cartilage. There are only a few reports about outcome after cartilage restoration surgery in the literature, and microfracturing is the surgical technique that has been most investigated.
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Affiliation(s)
- S Bouaicha
- Orthopädische Klinik, Universitätsklinik Balgrist Zürich, Forchstrasse 340, 8008, Zürich, Schweiz.
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31
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Pham TT, Kany J, Lakhal W, Sales de Gauzy J, Accadbled F. Arthroscopic Osteochondral Autograft Transfer for Juvenile Osteochondritis Dissecans of the Humeral Head: A Case Report. JBJS Case Connect 2017; 7:e63. [PMID: 29252892 DOI: 10.2106/jbjs.cc.17.00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Osteochondritis dissecans (OCD) rarely affects the humeral head. We describe a 14-year-old adolescent who, despite conservative treatment, had persistent pain in the left shoulder as well as limited function. Radiographs and a computed tomography (CT) arthrogram revealed an osteochondral defect of the humeral head. He was managed with an arthroscopic osteochondral autograft transfer from the knee, which provided a satisfactory outcome. CONCLUSION Arthroscopic osteochondral autograft transfer is an effective option for the treatment of OCD of the humeral head.
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Affiliation(s)
- Thuy Trang Pham
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Jean Kany
- Service de Chirurgie Orthopédique, Clinique de l'Union, Saint-Jean, France
| | - Walid Lakhal
- Service de Chirurgie Orthopédique Pédiatrique, Le Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Jérôme Sales de Gauzy
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Franck Accadbled
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
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Bateman DK, Black EM, Lazarus MD, Abboud JA. Outcomes Following Arthroscopic Repair of Posterior Labral Tears in Patients Older Than 35 Years. Orthopedics 2017; 40:e305-e311. [PMID: 27925639 DOI: 10.3928/01477447-20161128-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/12/2016] [Indexed: 02/03/2023]
Abstract
Although the results of arthroscopic management of posterior labral pathology in young athletes have been reported extensively in the literature, the clinical outcomes in older patients are unknown. This retrospective review included patients older than 35 years who underwent arthroscopic posterior labral repair. Functional outcome scores were collected, and subgroup analyses were performed to evaluate the impact of patient-specific factors. Forty-three patients met the inclusion criteria; average follow-up was 36.9 months (range, 24-54 months). Mean patient age at the time of surgery was 40.9 years (range, 35-57 years). Average outcome scores at final follow-up were Quick Disabilities of the Arm, Shoulder and Hand Scale (QuickDASH), 19±22; Simple Shoulder Test (SST), 9.9±3; Western Ontario Shoulder Instability Index (WOSI), 601±546; and Single Assessment Numeric Evaluation (SANE), 79.6%±23.4%. No significant differences in outcomes were observed in patients with preoperative symptomatic instability, active workers' compensation claims, or traumatic injury (P>.05). The presence of intraoperatively definable chondral damage (Outerbridge grade III or higher) was associated with significantly worse final functional outcomes (QuickDASH: 29 vs 11.9, P=.03; SST: 8.5 vs 10.9, P=.02; WOSI: 875 vs 407, P=.01; and SANE: 70.6% vs 86%, P=.05). One patient (2%) experienced a minor postoperative complication, and 3 patients (7%) required subsequent procedures: 2 total shoulder arthroplasties and 1 revision labral repair. The results of arthroscopic posterior labral repair in patients older than 35 years were variable and worse than those previously reported in younger patients. The presence of chondral damage at the time of the index procedure was a negative predictive factor. [Orthopedics. 2017; 40(2):e305-e311.].
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Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J 2017; 11:163-182. [PMID: 28400884 PMCID: PMC5366381 DOI: 10.2174/1874325001711010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/17/2022] Open
Abstract
Background: Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field. Methods: This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies. Results: Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies. Conclusion: The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.
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Affiliation(s)
- Dimitrios Giotis
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Ashkan Aryaei
- Department of Biomedical Engineering, University of California, Davis, USA
| | - Theofanis Vasilakakos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, USA
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Capito NM, Owens BD, Sherman SL, Smith MJ. Osteochondral Allografts in Shoulder Surgical Procedures. JBJS Rev 2016; 4:01874474-201611000-00003. [PMID: 27922984 DOI: 10.2106/jbjs.rvw.16.00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of fresh osteochondral allografts has become popular in many joint-preserving orthopaedic procedures and shows early promising results within the shoulder. Distal tibial allograft contains a stout cartilaginous layer that appears to have highly congruent curvature and concavity to the glenoid, which makes for an optimal allograft option for instability. In the setting of large Hill-Sachs lesions, the use of a humeral-head osteochondral allograft is essential to restore geometry, stability, and mechanics of the native glenohumeral joint. One must be cautious with the treatment of glenoid chondral lesions with osteoarticular grafting procedures because of the depth of the glenoid compared with the depth of subchondral bone on the graft necessary to achieve a press fit, and advanced imaging is recommended when planning an operative intervention. Optimizing joint-preservation treatment with osteochondral allografts will rely on the long-term results of these procedures, and careful patient selection, preoperative discussion, and realistic expectations are necessary.
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Schoch B, Werthel JD, Cofield R, Sanchez-Sotelo J, Sperling JW. Shoulder arthroplasty for chondrolysis. J Shoulder Elbow Surg 2016; 25:1470-6. [PMID: 27038563 DOI: 10.1016/j.jse.2016.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chondrolysis is a rare complication after shoulder arthroscopy leading to early joint destruction. Shoulder arthroplasty may be considered for end-stage chondrolysis, but concerns exist about implant survivorship, given the younger age of this population. This study aimed to assess pain relief, function, and survivorship of shoulder arthroplasty for chondrolysis and to assess risk factors for failure. METHODS Between January 2000 and January 2013, 26 consecutive shoulders with chondrolysis were treated at our institution with shoulder arthroplasty. All shoulders had a prior arthroscopic procedure that predated a phase of rapid joint destruction. Twenty-three shoulders were followed up for a minimum of 2 years or until reoperation (mean, 4.0 years; range, 0.7-8.6 years). The mean age of the patients was 40 years (range, 21-58 years). Outcome measures included pain, range of motion, postoperative modified Neer ratings, American Shoulder and Elbow Surgeons scores, complications, and reoperations. RESULTS At most recent follow-up, only 14 of 23 shoulders had no or mild pain. Overall pain scores improved from 4.7 to 2.6 points. Abduction and external rotation improved significantly. Five shoulders required reoperation, 2 for glenoid loosening and 1 each for infection, instability, and stiffness. Subjectively, 8 patients rated their shoulder as much better, 7 as better, 4 the same, and 4 worse. Most recent American Shoulder and Elbow Surgeons scores averaged 64 points (range, 20-95 points). CONCLUSIONS Shoulder arthroplasty for the treatment of chondrolysis improves pain and range of motion. However, patient satisfaction is variable. Early follow-up shows a higher than expected rate of reoperation (25%). Patients undergoing shoulder arthroplasty for chondrolysis should be counseled appropriately about expectations after surgery.
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Affiliation(s)
- Bradley Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Robert Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Wang VM, Karas V, Lee AS, Yin Z, Van Thiel GS, Hussey K, Sumner DR, Chubinskaya S, Magin RL, Verma NN, Romeo AA, Cole BJ. Assessment of glenoid chondral healing: comparison of microfracture to autologous matrix-induced chondrogenesis in a novel rabbit shoulder model. J Shoulder Elbow Surg 2015; 24:1789-800. [PMID: 26238005 PMCID: PMC4618188 DOI: 10.1016/j.jse.2015.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/19/2015] [Accepted: 06/01/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of glenohumeral arthrosis in young patients is a considerable challenge, with a growing need for non-arthroplasty alternatives. The objectives of this study were to develop an animal model to study glenoid cartilage repair and to compare surgical repair strategies to promote glenoid chondral healing. METHODS Forty-five rabbits underwent unilateral removal of the entire glenoid articular surface and were divided into 3 groups--untreated defect (UD), microfracture (MFx), and MFx plus type I/III collagen scaffold (autologous matrix-induced chondrogenesis [AMIC])--for the evaluation of healing at 8 weeks (12 rabbits) and 32 weeks (33 rabbits) after injury. Contralateral shoulders served as unoperated controls. Tissue assessments included 11.7-T magnetic resonance imaging (long-term healing group only), equilibrium partitioning of an ionic contrast agent via micro-computed tomography (EPIC-μCT), and histologic investigation (grades on International Cartilage Repair Society II scoring system). RESULTS At 8 weeks, x-ray attenuation, thickness, and volume did not differ by treatment group. At 32 weeks, the T2 index (ratio of T2 values of healing to intact glenoids) was significantly lower for the MFx group relative to the AMIC group (P = .01) whereas the T1ρ index was significantly lower for AMIC relative to MFx (P = .01). The micro-computed tomography-derived repair tissue volume was significantly higher for MFx than for UD. Histologic investigation generally suggested inferior healing in the AMIC and UD groups relative to the MFx group, which exhibited improvements in both integration of repair tissue with subchondral bone and tidemark formation over time. DISCUSSION Improvements conferred by AMIC were limited to magnetic resonance imaging outcomes, whereas MFx appeared to promote increased fibrous tissue deposition via micro-computed tomography and more hyaline-like repair histologically. The findings from this novel model suggest that MFx promotes biologic resurfacing of full-thickness glenoid articular injury.
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Affiliation(s)
- Vincent M Wang
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vasili Karas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew S Lee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ziying Yin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Kristen Hussey
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - D Rick Sumner
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Susan Chubinskaya
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - Richard L Magin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Lubowitz JH. Editorial Commentary: Shoulder Arthroscopy, Shoulder Hemiarthroplasty, and Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis. Arthroscopy 2015; 31:1167-8. [PMID: 26048766 DOI: 10.1016/j.arthro.2015.04.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 02/02/2023]
Abstract
Shoulder arthroscopy offers a safe, effective, and less invasive alternative to arthroplasty in patients under 60 years of age with glenohumeral arthritis. However, indications include joint space of greater than 2 mm. For patients who do not meet arthroscopic indications, total shoulder arthroplasty is more effective than hemiarthroplasty. Performance and publication bias may effect generalizability of these findings. Biologic treatment options seem on the horizon.
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Anderl W, Kriegleder B, Neumaier M, Laky B, Heuberer P. Arthroscopic partial shoulder resurfacing. Knee Surg Sports Traumatol Arthrosc 2015; 23:1563-1570. [PMID: 24752534 DOI: 10.1007/s00167-014-2981-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 03/30/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to report patients' clinical and subjective outcomes 2 years after arthroscopic-assisted partial resurfacing of the humeral head. METHODS In this prospective case series, 11 patients (4 females, 7 males; median age, 59 years; range 47-72) underwent arthroscopic-assisted partial shoulder resurfacing between April 2010 and March 2011. Clinical conditions and subjective assessments were evaluated before surgery and at 6 weeks, 3 and 6 months, and then annually after surgery using the Constant score (CS), active range of motion (ROM), the visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons scale (ASES), and the subjective shoulder value (SSV). Radiological outcomes and major complications were monitored. RESULTS The mean CS improved significantly from 54.6 ± 13.6 preoperatively to 72.9 ± 17.2 points 6 weeks postoperatively (P = 0.009). At the 2-year follow-up, the mean CS had further increased to 86.5 ± 14.3 points (P < 0.001). Trends towards increasing ROMs were detected. VAS, ASES, and SSV significantly improved from baseline to the first follow-up and maintained improvement after 2 years. One patient required revision surgery owing to a technical failure and two patients because of rapidly progressive osteoarthritis. Ten of 11 patients (91 %) claimed that they would undergo arthroscopic partial shoulder resurfacing again. CONCLUSION Arthroscopic-assisted partial humeral head resurfacing, which has the advantages of bone stock preservation and the maintenance of an intact subscapularis tendon, allowed immediate postoperative mobilization and provided significant improvements in subjective outcomes, especially for pain relief in active patients without severe glenoid cartilage wear. LEVEL OF EVIDENCE Therapeutic case series, Level IV.
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Affiliation(s)
- Werner Anderl
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
| | - Bernhard Kriegleder
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Manfred Neumaier
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Brenda Laky
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Philipp Heuberer
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
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Sweet SJ, Takara T, Ho L, Tibone JE. Primary partial humeral head resurfacing: outcomes with the HemiCAP implant. Am J Sports Med 2015; 43:579-87. [PMID: 25564407 DOI: 10.1177/0363546514562547] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Humeral head defects such as degenerative disease or avascular necrosis are often treated with stemmed hemiarthroplasty or total shoulder arthroplasty. Despite its historical and clinical significance, stemmed humeral head replacement poses inherent technical challenges to placing spherical implants at the anatomically correct head height, version, and neck-shaft angle. PURPOSE The aim of this study was to assess humeral head inlay arthroplasty as a joint-preserving alternative that maintains the individual head-neck-shaft anatomy. Humeral head inlay arthroplasty also allows intraoperative surface mapping and placement of a contoured articular component that is matched to the patient's defect size, location, and individual surface geometry. STUDY DESIGN Case series; Level of evidence, 4. METHODS This retrospective case series included 19 patients (20 shoulders), with an average age of 48.9 years (range, 32-58 years; 16 men, 3 women). Preoperative diagnoses were osteoarthritis in 16 shoulders and osteonecrosis in 4 shoulders. Pre- and postoperative evaluations included physical examination, radiographic assessment, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, the Simple Shoulder Test, a pain visual analog scale, and patient satisfaction rating. RESULTS The mean follow-up period was 32.7 months (range, 17-66 months). The mean American Shoulder and Elbow Surgeons score improved from 24.1 to 78.8, mean Simple Shoulder Test score from 3.95 to 9.3, mean visual analog scale score from 8.2 to 2.1, mean forward flexion from 100° to 129°, and mean external rotation from 23° to 43° (P < .001 for all). Radiographic follow-up showed no evidence of periprosthetic fracture, component loosening, osteolysis, or device failure. Patient shoulder self-assessment was 90% poor before surgery and improved to 75% good to excellent at last follow-up; 20% of patients self-rated as somewhat good to somewhat poor, and 5% self-rated as poor. Ninety percent of patients were satisfied with the choice of the procedure. Three patients had postoperative complications unrelated to the implants, including a partial rotator cuff tear treated with physical therapy, preexisting glenoid wear treated with arthroscopic debridement and microfracture, and infection complicated by subscapularis rupture requiring several subsequent surgical procedures but with retention of the implant. CONCLUSION Humeral head inlay arthroplasty is effective in providing pain relief, functional improvement, and patient satisfaction. Rather than delaying shoulder arthroplasty to end-stage osteoarthritis, humeral head inlay arthroplasty is a promising new direction in primary shoulder arthroplasty for younger and active patients with earlier stage disease.
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Affiliation(s)
- Stephan J Sweet
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tad Takara
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lance Ho
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Lubowitz JH, Provencher MT, Brand JC, Rossi MJ. Arthroscopic arthritis options are on the horizon. Arthroscopy 2015; 31:389-92. [PMID: 25744317 DOI: 10.1016/j.arthro.2015.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 02/02/2023]
Abstract
Arthroscopic treatment options are on the horizon for cartilage defects and arthritis. While arthroscopy is not a "cure" for osteoarthritis, arthroscopic and related surgery is of significant benefit to many patients with intra-articular pathology including osteoarthritis and articular cartilage disease. However, arthroscopy alone is insufficient, and arthroscopic treatment of patients with arthritis is a salvage procedure requiring an approach where arthroscopy must be combined with additional procedures. There are degrees of osteoarthritis severity, and arthroscopy is more effective in combination with additional procedures in younger patients, in more active patients, and in patients with less severe disease, or smaller lesions. On another note, we continue to be fascinated by the knee anterolateral ligament, although to date its clinical relevance is entirely speculative.
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Camp CL, Barlow JD, Krych AJ. Transplantation of a tibial osteochondral allograft to restore a large glenoid osteochondral defect. Orthopedics 2015; 38:e147-52. [PMID: 25665122 DOI: 10.3928/01477447-20150204-92] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/24/2014] [Indexed: 02/03/2023]
Abstract
Osteochondral disease of the glenoid is a well-known cause of shoulder pain and disability in young and active patients. The etiology can be multifactorial, and disease severity can exist across a wide spectrum. Symptoms can often interfere with athletic performance, job responsibilities, and activities of daily living. Although a number of cartilage restoration techniques exist for other joints, such as the hip, knee, ankle, and elbow, restorative options for glenoid osteochondral defects are currently limited. Given the success of osteochondral allograft transplantation in other joints, the authors hypothesized that osteochondral allograft transplantation may be a reasonable option in treating osteochondral disease of the glenoid if a suitable donor source could be identified. After performing the procedure in a cadaveric model, the authors found the articular geometry of the medial tibial plateau to closely resemble that of the glenoid articular surface. This graft option is advantageous because it is readily accessible from allograft tissue banks, whereas glenoid allografts are not currently available. After failure of extensive nonoperative treatment, a former multisport athlete underwent osteochondral allograft transplantation of a large glenoid defect with a medial tibial plateau osteochondral allograft. After 1 year of follow-up, the patient showed significant improvement in the subjective shoulder value (from 40% to 99%), QuickDASH score (from 36 to 2), and American Shoulder and Elbow Score (from 46 to 92). Ultimately, medial tibial plateau allograft was a viable option for treatment of an osteochondral glenoid defect in this patient, and additional study of this treatment strategy is warranted.
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Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation. Eur Radiol 2014; 25:961-9. [PMID: 25377772 DOI: 10.1007/s00330-014-3469-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/13/2014] [Accepted: 10/15/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the diagnostic performance of multi-detector CT arthrography (CTA) and 1.5-T MR arthrography (MRA) in detecting hyaline cartilage lesions of the shoulder, with arthroscopic correlation. PATIENTS AND METHODS CTA and MRA prospectively obtained in 56 consecutive patients following the same arthrographic procedure were independently evaluated for glenohumeral cartilage lesions (modified Outerbridge grade ≥2 and grade 4) by two musculoskeletal radiologists. The cartilage surface was divided in 18 anatomical areas. Arthroscopy was taken as the reference standard. Diagnostic performance of CTA and MRA was compared using ROC analysis. Interobserver and intraobserver agreement was determined by κ statistics. RESULTS Sensitivity and specificity of CTA varied from 46.4 to 82.4 % and from 89.0 to 95.9 % respectively; sensitivity and specificity of MRA varied from 31.9 to 66.2 % and from 91.1 to 97.5 % respectively. Diagnostic performance of CTA was statistically significantly better than MRA for both readers (all p ≤ 0.04). Interobserver agreement for the evaluation of cartilage lesions was substantial with CTA (κ = 0.63) and moderate with MRA (κ = 0.54). Intraobserver agreement was almost perfect with both CTA (κ = 0.94-0.95) and MRA (κ = 0.83-0.87). CONCLUSION The diagnostic performance of CTA and MRA for the detection of glenohumeral cartilage lesions is moderate, although statistically significantly better with CTA. KEY POINTS • CTA has moderate diagnostic performance for detecting glenohumeral cartilage substance loss. • MRA has moderate diagnostic performance for detecting glenohumeral cartilage substance loss. • CTA is more accurate than MRA for detecting cartilage substance loss.
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Shin JJ, Mellano C, Cvetanovich GL, Frank RM, Cole BJ. Treatment of glenoid chondral defect using micronized allogeneic cartilage matrix implantation. Arthrosc Tech 2014; 3:e519-22. [PMID: 25264514 PMCID: PMC4175152 DOI: 10.1016/j.eats.2014.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/22/2014] [Indexed: 02/03/2023] Open
Abstract
Focal chondral lesions of the glenohumeral joint, though less common than chondral defects in the knee or ankle, can be a significant source of pain in an active population. For patients in whom nonsurgical management fails, promising results have been reported after arthroscopic microfracture surgery to treat such lesions. However, microfracture leads to growth of fibrocartilage tissue and is biomechanically less durable than native hyaline cartilage. Recently, augmentation of the microfractured defect with micronized allogeneic cartilage and platelet-rich plasma has been described to restore hyaline-like cartilage and potentially protect the subchondral bone from postsurgical fracture biology within the base of the defect. We present a simple arthroscopic technique of implanting dehydrated, micronized allogeneic cartilage scaffold to treat an isolated chondral lesion of the glenoid.
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Affiliation(s)
| | | | | | | | - Brian J. Cole
- Address correspondence to Brian J. Cole, M.D., The Orthopedic Building at Rush University Medical Center, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.
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Rao AJ, Johnston TR, Harris AHS, Smith RL, Costouros JG. Inhibition of chondrocyte and synovial cell death after exposure to commonly used anesthetics: chondrocyte apoptosis after anesthetics. Am J Sports Med 2014; 42:50-8. [PMID: 24166803 DOI: 10.1177/0363546513507426] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An intra-articular injection of local anesthetics is a common procedure for diagnostic and therapeutic purposes. It has been shown that these agents are toxic to articular cartilage and synovial tissue in a dose- and time-dependent fashion, and in some cases, they may lead to postarthroscopic glenohumeral chondrolysis (PAGCL). However, the role of apoptosis in cell death is still unclear, and the potential role of apoptosis inhibition in minimizing chondrocyte and synovial cell death has not been reported. PURPOSE (1) To quantify the degree of apoptotic cell death in chondrocytes and synovial cells exposed to local anesthetics, and (2) to determine whether caspase inhibition could reduce cell death. STUDY DESIGN Controlled laboratory study. METHODS Human chondrocytes and synovial cells were expanded in vitro and exposed to normal saline, 0.5% bupivacaine, 0.5% ropivacaine, 1% lidocaine, or 1:1000 epinephrine for 90 minutes. Apoptosis was then detected at 1, 3, 5, and 7 days after exposure using terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL) and immunohistochemistry. Apoptosis was then inhibited using the pan-caspase inhibitor z-vad-fmk. Results were normalized to normal saline controls and analyzed by generalized regression models and pairwise confidence intervals. RESULTS Analysis of cumulative chondrocyte apoptosis relative to controls after anesthetic exposure demonstrated more than 60% cell death with 0.5% bupivacaine and 1:1000 epinephrine. The greatest chondroprotective effect of caspase inhibition occurred with 0.5% ropivacaine. Similarly, in synovial cells, epinephrine was also very cytotoxic; however, 1% lidocaine induced the most apoptosis. Synovial cells exposed to 0.5% ropivacaine were again most sensitive to protective caspase inhibition. CONCLUSION Local anesthetics induce chondrocyte and synovial cell apoptosis in a time-dependent fashion, with peak apoptosis occurring 5 days after exposure. Both chondrocytes and synovial cells are most sensitive to caspase inhibition after exposure to 0.5% ropivacaine. CLINICAL RELEVANCE Apoptosis inhibition may be an effective strategy in minimizing chondrocyte and synovial cell death after exposure to anesthetics. Further investigation is clinically warranted.
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Affiliation(s)
- Allison J Rao
- John G. Costouros, FACS, Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Mailcode 6342, Redwood City, CA 94063.
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Elsharkawi M, Cakir B, Reichel H, Kappe T. Reliability of radiologic glenohumeral osteoarthritis classifications. J Shoulder Elbow Surg 2013; 22:1063-7. [PMID: 23375877 DOI: 10.1016/j.jse.2012.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 10/30/2012] [Accepted: 11/11/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was conducted to determine the intraobserver and interobserver reliability of glenohumeral osteoarthritis classification schemes. MATERIALS AND METHODS The plain radiographs of 108 shoulder joints from 96 consecutive patients with glenohumeral osteoarthritis treated at our institution were graded into 6 classification systems by 2 observers on 2 occasions. The intraobserver and interobserver reliability of the classification schemes were determined by using Cohen's κ coefficient and weighted according to Landis and Koch. RESULTS The intraobserver and interobserver reliabilities were 0.907 (observer 1), 0.965 (observer 2), and 0.851 (interobserver) for the Samilson-Prieto grading system; 0.954, 0.948, and 0.869 for the Allain modification; 0.936, 0.830, and 0.791 for the Gerber modification; 0.887, 0.892, and 0.744 for the Kellgren and Lawrence classification; 0.873, 0.964, and 0.935 for the Weinstein; and 0.854, 0.934, and 0.797 for the Guyette grading system. CONCLUSION The classification systems according to Weinstein and Guyette and the modifications of the Samilson-Prieto classification according to Allain and Gerber showed a comparable reliability with the commonly used glenohumeral osteoarthritis grading systems according to Samilson-Prieto and Kellgren-Lawrence. Thus, they are recommended for clinical and especially scientific purposes.
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Affiliation(s)
- Mohammed Elsharkawi
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, Ulm, Germany
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Operative treatment of chondral defects in the glenohumeral joint. Arthroscopy 2012; 28:1889-901. [PMID: 22796143 DOI: 10.1016/j.arthro.2012.03.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 03/17/2012] [Accepted: 03/22/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The objectives of this study were to conduct a systematic review of clinical outcomes after cartilage restorative and reparative procedures in the glenohumeral joint, to identify prognostic factors that predict clinical outcomes, to provide treatment recommendations based on the best available evidence, and to highlight literature gaps that require future research. METHODS We searched Medline (1948 to week 1 of February 2012) and Embase (1980 to week 5 of 2012) for studies evaluating the results of arthroscopic debridement, microfracture, osteochondral autograft or allograft transplants, and autologous chondrocyte implantation for glenohumeral chondral lesions. Other inclusion criteria included minimum 8 months' follow-up. The Oxford Level of Evidence Guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were used to rate the quality of evidence and to make treatment recommendations. RESULTS Twelve articles met our inclusion criteria, which resulted in a total of 315 patients. Six articles pertained to arthroscopic debridement (n = 249), 3 to microfracture (n = 47), 2 to osteochondral autograft transplantation (n = 15), and 1 to autologous chondrocyte implantation (n = 5). Whereas most studies reported favorable results, sample heterogeneity and differences in the use of functional and radiographic outcomes precluded a meta-analysis. Several positive and negative prognostic factors were identified. All of the eligible studies were observational, retrospective case series without control groups; the quality of evidence available for the use of the aforementioned procedures is considered "very low" and "any estimate of effect is very uncertain." CONCLUSIONS More research is necessary to determine which treatment for chondral pathology in the shoulder provides the best long-term outcomes. We encourage centers to establish the necessary alliances to conduct blinded, randomized clinical trials and prospective, comparative cohort studies necessary to rigorously determine which treatments result in the most optimal outcomes. At this time, high-quality evidence is lacking to make strong recommendations, and decision making in this patient population is performed on a case-by-case basis. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Abstract
Background The articular cartilage of the shoulder is not endowed with intrinsic repair abilities, so the detection of chondral lesions during arthroscopy may indicate that additional articular procedures are needed. The aim of the current study was to evaluate the benefits of arthroscopy in patients with early shoulder arthritis, and to assess which clinical and radiological features are correlated with better arthroscopic outcomes. Materials and methods Out of a total of 2,707 shoulders, 61 arthroscopies were performed on patients aged 30–55 years suffering from a painful early arthritic shoulder. We performed a retrospective study of 47 of those 61 patients with osteoarthritis at Samilson–Prieto stage I or II. SST and Constant score were used as outcome measures. Arthroscopic circumferential capsulotomy was performed to release the soft tissues and increase the joint space. Glenoid chondral lesions were caregorized according to location (anterior, posterior, centered) and size (small, large, total) and treated with microfractures; in the last 11 patients, we placed a engineered hyaluronic acid membrane, Hyalograft® C, on the surface of the glenoid. Postoperative care included mobilization the day after surgery, with the arm protected in a sling for two weeks. Follow-up examinations were performed at 3, 6, 12, and 24 months after surgery. The clinical and radiographic data collected were compared with those obtained at the last examination. Results The mean Constant score increased from 43.8 points to 79.1, and the mean SST score increased from 4.9 points to 9.4 points. Clinical outcomes improved significantly in 44 patients (93.6 %). The three patients (6.4 %) with the lowest scores showed progression of arthritis. Age, gender, glenohumeral distance, and presence of engineered hyaluronic acid membrane were not related to clinical scores. Recovery of range of motion as well as small and centered cartilage lesions were statistically associated with improved outcome. Conclusion The main finding was that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions.
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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.
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Becce F, Richarme D, Omoumi P, Djahangiri A, Farron A, Meuli R, Theumann N. Direct MR arthrography of the shoulder under axial traction: feasibility study to evaluate the superior labrum-biceps tendon complex and articular cartilage. J Magn Reson Imaging 2012; 37:1228-33. [PMID: 23019063 DOI: 10.1002/jmri.23824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 08/15/2012] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess the value of adding axial traction to direct MR arthrography of the shoulder, in terms of subacromial and glenohumeral joint space widths, and coverage of the superior labrum-biceps tendon complex and articular cartilage by contrast material. MATERIALS AND METHODS Twenty-one patients investigated by direct MR arthrography of the shoulder were prospectively included. Studies were performed with a 3 Tesla (T) unit and included a three-dimensional isotropic fat-suppressed T1-weighted gradient-recalled echo sequence, without and with axial traction (4 kg). Two radiologists independently measured the width of the subacromial, superior, and inferior glenohumeral joint spaces. They subsequently rated the amount of contrast material around the superior labrum-biceps tendon complex and between glenohumeral cartilage surfaces, using a three-point scale: 0 = no, 1 = partial, 2 = full. RESULTS Under traction, the subacromial (Δ = 2.0 mm, P = 0.0003), superior (Δ = 0.7 mm, P = 0.0001) and inferior (Δ = 1.4 mm, P = 0.0006) glenohumeral joint space widths were all significantly increased, and both readers noted significantly more contrast material around the superior labrum-biceps tendon complex (P = 0.014), and between the superior (P = 0.001) and inferior (P = 0.025) glenohumeral cartilage surfaces. CONCLUSION Direct MR arthrography of the shoulder under axial traction increases subacromial and glenohumeral joint space widths, and prompts better coverage of the superior labrum-biceps tendon complex and articular cartilage by contrast material.
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Affiliation(s)
- Fabio Becce
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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van der Meijden OA, Gaskill TR, Millett PJ. Glenohumeral joint preservation: a review of management options for young, active patients with osteoarthritis. Adv Orthop 2012; 2012:160923. [PMID: 22536514 PMCID: PMC3318219 DOI: 10.1155/2012/160923] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 01/22/2012] [Accepted: 01/24/2012] [Indexed: 02/03/2023] Open
Abstract
The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement. Several palliative and restorative techniques are currently optional. Joint debridement has shown good results and a combination of arthroscopic debridement with a capsular release, humeral osteoplasty, and transcapsular axillary nerve decompression seems promising when humeral osteophytes are present. Currently, microfracture seems the most studied reparative treatment modality available. Other techniques, such as autologous chondrocyte implantation and osteochondral transfers, have reportedly shown potential but are currently mainly still investigational procedures. This paper gives an overview of the currently available joint preserving surgical techniques for glenohumeral osteoarthritis.
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Affiliation(s)
- Olivier A. van der Meijden
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Trevor R. Gaskill
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Peter J. Millett
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
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