Tags

Type your tag names separated by a space and hit enter

Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes.
Cartilage 2019; :1947603519870858C

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.

Authors+Show Affiliations

1 Mayo Clinic, Rochester, MN, USA.1 Mayo Clinic, Rochester, MN, USA.1 Mayo Clinic, Rochester, MN, USA.1 Mayo Clinic, Rochester, MN, USA.1 Mayo Clinic, Rochester, MN, USA.1 Mayo Clinic, Rochester, MN, USA.1 Mayo Clinic, Rochester, MN, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31441316

Citation

Fiegen, Anthony, et al. "Articular Cartilage Defects of the Glenohumeral Joint: a Systematic Review of Treatment Options and Outcomes." Cartilage, 2019, p. 1947603519870858.
Fiegen A, Leland DP, Bernard CD, et al. Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes. Cartilage. 2019.
Fiegen, A., Leland, D. P., Bernard, C. D., Krych, A. J., Barlow, J. D., Dahm, D. L., & Camp, C. L. (2019). Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes. Cartilage, p. 1947603519870858. doi:10.1177/1947603519870858.
Fiegen A, et al. Articular Cartilage Defects of the Glenohumeral Joint: a Systematic Review of Treatment Options and Outcomes. Cartilage. 2019 Aug 23;1947603519870858. PubMed PMID: 31441316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes. AU - Fiegen,Anthony, AU - Leland,Devin P, AU - Bernard,Christopher D, AU - Krych,Aaron J, AU - Barlow,Jonathan D, AU - Dahm,Diane L, AU - Camp,Christopher L, Y1 - 2019/08/23/ PY - 2019/8/24/pubmed PY - 2019/8/24/medline PY - 2019/8/24/entrez KW - cartilage KW - glenohumeral KW - joint preservation KW - osteochondral SP - 1947603519870858 EP - 1947603519870858 JF - Cartilage JO - Cartilage N2 - 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. SN - 1947-6043 UR - https://www.unboundmedicine.com/medline/citation/31441316/Articular_Cartilage_Defects_of_the_Glenohumeral_Joint:_A_Systematic_Review_of_Treatment_Options_and_Outcomes L2 - http://journals.sagepub.com/doi/full/10.1177/1947603519870858?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -