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Pieringer A, Do A, Freislederer F, Scheibel M. Single-Stage Arthroscopic Minced Cartilage Implantation for Focal Cartilage Defects of the Glenoid Including Glenolabral Articular Disruption Lesions: A Technical Note. Arthrosc Tech 2024; 13:103049. [PMID: 39308588 PMCID: PMC11411353 DOI: 10.1016/j.eats.2024.103049] [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: 01/18/2024] [Accepted: 04/07/2024] [Indexed: 09/25/2024] Open
Abstract
Anterior shoulder dislocations often are associated with cartilage defects of the anterior glenoid (glenolabral articular disruption, or GLAD lesions). However, the importance of GLAD lesions for shoulder stability is usually greatly underestimated. Moreover, glenoid cartilage defects may have a high clinical relevance as the result of persistent pain and possible progression to osteoarthritis. Therefore, surgical treatment appears to be necessary. Although in older patients prosthetic arthroplasty is a useful treatment option for progressive symptomatic cartilage defects, there is still disagreement about the ideal joint-preserving method for the treatment of isolated glenoid cartilage defects, especially in younger and more active patients. In recent years, autologous chondrocyte implantation has been established as a promising treatment option for focal cartilage defects. However, most autologous chondrocyte implantation techniques have the disadvantage of requiring 2 surgical procedures and the availability of specialized laboratories, making the techniques complex and expensive. In contrast, the AutoCart procedure (Arthrex, Munich, Germany) is a cost-effective one-step procedure in which the cartilage defect is filled with a mixture of minced autologous cartilage and autologous conditioned plasma and has already shown good clinical results in the knee joint. We present an arthroscopic technique for use in glenoid cartilage defects.
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Affiliation(s)
- Alexander Pieringer
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Anh Do
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Florian Freislederer
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Abed V, Javid K, Akins X, Kane P, Stone AV. Gunshot-Induced Humeral Head Osteochondral Defect Treated with an Osteochondral Allograft: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00032. [PMID: 39146442 DOI: 10.2106/jbjs.cc.24.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
CASE A 25-year-old right-hand dominant male police officer presented to the emergency department with a gunshot wound to his left shoulder. Magnetic resonance imaging demonstrated an osteochondral defect overlying the humeral head along the mid to lower aspect of the glenohumeral joint. A staged operation with shoulder arthroscopy followed by an osteochondral allograft (OCA) of the humeral head was performed. During his 6-month postoperative visit, he had returned to full work duty with no restrictions and reported that his pain was well controlled. CONCLUSION Humeral head OCA transplantation may be an effective treatment option for traumatic osteochondral lesions of the glenohumeral joint.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
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Ganokroj P, Adriani M, Whalen RJ, Provencher MT. Treatment of Shoulder Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:87-94. [PMID: 38978202 DOI: 10.1097/jsa.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Articular cartilage defects in the glenohumeral joint may be found in laborers, the elderly, and young athletes, among others. Various factors can contribute to cartilage damage, including prior surgery, trauma, avascular necrosis, inflammatory arthritis, joint instability, and osteoarthritis. There is a wide variety of treatment options, from conservative treatment, injections, and surgical options, including arthroscopic debridement, microfracture, osteochondral autograft transfer, osteochondral graft transplantation, autologous chondrocyte implantation, and the newly emerging techniques such as biologic augmentation. There is a challenge to determine the optimal treatment options, especially for young athletes, due to limited outcomes in the literature. However, there are many options which are viable to address osteochondral defects of the glenohumeral joint.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, CO
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
| | - Marco Adriani
- Steadman Philippon Research Institute, Vail, CO
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Radtke L, Guy C, Da Silva A, Maak T, Chalmers P. Distal tibia osteochondral allograft as a successful treatment for a glenoid chondral defect in a pediatric patient. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:315-318. [PMID: 38706665 PMCID: PMC11065745 DOI: 10.1016/j.xrrt.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Logan Radtke
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Cameron Guy
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Adrik Da Silva
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Travis Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Peter Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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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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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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Hill BW, Singh AM, Astolfi M, Horneff JG, Schoch BS, Abboud JA. Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis. J Shoulder Elbow Surg 2021; 30:S66-S70. [PMID: 33892120 DOI: 10.1016/j.jse.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The benefit of rotator cuff repair (RCR) in patients with concurrent osteoarthritic changes remains unclear. RCR has the theoretical potential to increase the compressive force across the glenohumeral joint, further exacerbating osteoarthritis pain. The purpose of this study is to investigate pain relief and patient-reported outcomes of patients undergoing simultaneous RCR and microfracture of focal glenohumeral osteoarthritis. METHODS Thirty-four patients undergoing simultaneous RCR and microfracture were retrospectively reviewed at a minimum 1-year follow-up. Patient demographics, preoperative range of motion, functional outcomes (visual analog scale [VAS], Single Assessment Numeric Evaluation [SANE], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], and Simple Shoulder Test [SST]), and operative metrics were recorded. The patients were then contacted to obtain postoperative functional outcome scores (VAS, SANE, ASES, and SST). RESULTS Twenty-seven patients (11 male/16 female [79%]) were evaluated at a mean follow-up of 25.8 months (range, 12-46). The average age at surgery was 64.9 years (range, 56-78). Chronic tears were more common than acute tears (57.7% vs. 42.3%). The majority of patients had a full rotator cuff tear (89%) involving a mean 1.7 ± 0.8 tendons (range, 1-3). Eighty-eight percent of the humeral lesions were Outerbridge 4 compared with 84% on the glenoid. The mean estimated involvement between the 2 groups with 38.4% ± 18.4% of the humeral head involved and 34.6% ± 18.4% of the glenoid involved. PRO scores improved postoperatively with a reduction in mean VAS (6.6-2.0, P < .01), SANE (33.8-79.8, P < .01), ASES (38.0-80.9, P < .01), and SST (3.07-9.70, P < .01) scores. Cumulatively, only 52% (14/27) of the patients improved, however, by the MCID for all collected PROs. CONCLUSIONS Our results demonstrate modest improvements in postoperative pain and functional scores at a minimum of 1-year follow-up in a cohort of patients who have undergone RCR and glenohumeral microfracture. In cases of small focal lesions of full-thickness cartilage loss, RCR with microfracture is a reasonable treatment option; however, patients should be counseled on expectations accordingly.
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Affiliation(s)
- Brian W Hill
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Arjun M Singh
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Matthew Astolfi
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - J Gabe Horneff
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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O'Brien MC, Dzieza WK, Bruner ML, Farmer KW. Assessment of Safe Cartilage Harvesting Quantity in the Shoulder: A Cadaveric Study. Arthrosc Sports Med Rehabil 2020; 3:e115-e120. [PMID: 33615255 PMCID: PMC7879179 DOI: 10.1016/j.asmr.2020.08.016] [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: 01/31/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the volume and yield of morselized cartilage that can be harvested from the shoulder for immediate reimplantation and repair. Methods A standard arthroscopic approach was used to harvest non–load-bearing cartilage from 5 cadaveric shoulder specimens. Cartilage was separated from the humerus, grasped, added to the cartilage particulator, and morselized to form a cartilage paste. The volume of reclaimed cartilage was measured and compared with average humeral and glenoid defects. Results The total yield of cartilage paste following tissue processing that was obtained from the 5 glenohumeral joints ranged from 1.0 mL to 2.4 mL with a mean volume of 1.9 ± 0.5 mL, yielding a theoretical 18.6 cm2 ± 5.2 cm2 of coverage with a 1-mm monolayer. Previously reported mean glenoid defect size ranges from 1.12 cm2 to 2.73 cm2, while the mean humeral defect size ranges from 4.22 cm2 to 6.00 cm2. Conclusions This study validated that through a single-stage surgical and processing technique it is possible to obtain a sufficient volume for re-implantable autologous morselized cartilage graft to address most glenohumeral articular cartilage defects. Clinical Relevance Chondrocyte grafts have been shown to be effective in cartilage repair. A single-site, single-staged procedure that uses a patient’s autologous shoulder cartilage from the same joint has the potential to reduce morbidity associated with multiple surgical sites, multistaged procedures, or nonautologous tissue in shoulder surgery.
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Affiliation(s)
- Michael C O'Brien
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, U.S.A.,College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Wojciech K Dzieza
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, U.S.A.,College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Michelle L Bruner
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin W Farmer
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, U.S.A
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