Abstract
Focal full-thickness articular cartilage lesions of the shoulder are less common than those of the lower extremity but are often symptomatic and may progress to degenerative osteoarthritis. This prospective study evaluated our clinical results for cartilage repair in five patients with chondral defects localized at the humeral head using a combination of microfracture and periostal flap, all by deltoidopectoral approach. Mean follow-up was 25.8 months (range 24–31) and consisted of a clinical examination, Constant score examination, radiography, and magnetic resonance imaging; three patients underwent a second-look arthroscopy an average of 8 months following cartilage repair. We found the Constant score significantly improved over the preoperative level, from 43.4% to 81.8%. Pain was reduced significantly to 18.6 points. Radiography and magnetic resonance imaging showed progression of the osteoarthritis in two patients. Second-look arthroscopy revealed a significantly reduced cartilage lesion. This is the first report of a combination of microfracture and a periostal flap for repair of focal full-thickness cartilage lesions at the shoulder. Short-term follow-up clinical results were satisfactory. It is essential to address the underlying pathology. Results must be reconfirmed in a long-term study.
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Akizuki S, Yasukawa Y (1997) Does arthroscopic arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone. Arthroscopy 13:9–17
Alfredson H, Lorentzon R (1999) Superior results with continuous passive motion compared to active motion after periostal transplantation. A retrospective study of human patella cartilage defect treatment. Knee Surg Sports Traumatol Arthrosc 7:232–238
Baumgaertner MR, Cannon WD, Vittori JM (1990) Arthroscopic debridement of the arthritic knee. Clin Orthop 253:197–202
Blevins FT, Steadman JR, Rodrigo JJ, Silliman J (1998) Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics 21:761–768
Bobic V (1996) Arthroscopic osteochondral autograft transplantation in ACL reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 3:262–264
Brittberg M, Lindahl A, Nilsson A, et al (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889
Buckwalter JA, Mankin HJ (1997) Articular cartilage. J Bone Joint Surg Am 79:600–611
Buckwalter JA, Mankin HJ (1997) Articular cartilage. II. Degeneration and osteoarthrosis, repair, regeneration and transplantation. J Bone Joint Surg Am 79:612–632
Cofield RH (1990) Degenerative and arthritic problems of the glenohumeral joint. In: Rockwood CA, Matsen FA (eds) The shoulder. Saunders, Philadelphia, pp 678–749
Ergelelet C, Browne JE, Fu F, Mandelbaum BR, Micheli LJ, Mosely JB (2000) Autologous chondrocyte transplantation for treatment of cartilage defects of the knee joint. Clinical results. Zentralbl Chir 125:516–522
Gerber C (1997) Observations on the classification of instability. In: Warner JJP, Ianotti JP, Gerber C (eds) Complex and revision problems in shoulder surgery. Lippincott-Raven, Philadelphia
Gill T (1997) The role of the microfracture technique in the treatment of full-thickness chondral injuries. Oper Techn Sports Med 8:138–140
Gillogly SD, Voight M, Blackburn T (1998) Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther 28:241–251
Habermeyer P (2002) Schulterchirurgie, 3rd edn. Urban & Fischer, Munich
Hangody L, Kish G, Karpati Z, Eberhart R (1997) Osteochondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral articular defects. Oper Techn Orthop 7:312–322
Hangody L, Kish G, Karpati Z, Udvarhelyi I, Szigeti I, Bely M (1998) Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics 21:751–755
Harryman DT, Ballmer FP, Harris SL, Sidles JA (1994) Arthroscopic labral repair to the glenoid rim. Arthroscopy 10:20–30 15
Hodler J, Loredo RA, Longo C, Trudell D, Yu JS, Resnick D (1995) Assessment of articular cartilage thickness of the humeral head: MR-anatomic correlation in cadavers. AJR Am J Roentgenol 165:615–620
Insall J (1974) The Pridie debridement operation for osteoarthritis of the knee. Clin Orthop 101:61–67
Jackson RW, Marans HJ, Silver RS (1988) Arthroscopic treatment of degenerative arthritis of the knee. J Bone Joint Surg Am 70: 332
Lorentzon R, Alfredson H, Hildingsson C (1998) Treatment of deep cartilage defects of the patella with periosteal transplantation. Knee Surg Sports Traumatol Arthrosc 6:202–208
Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB, Erggelet C, Minas T, Peterson L (1998) Current concepts: Articular cartilage lesions of the knee. Am J Sports Med 26:853–861
Meenen NM, Rischke B, Adamietz P, Dauner M, Fink J, Gopfert C, Rueger JM (1998) Treatment of cartilage defects. Langenbecks Arch Chir [Suppl]115:568–576
Minas T, Peterson L (1999) advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 18:13–44
Nakanishi K, Tanaka H, Nishii T, Masuhara K, Narumi Y, Nakamura H (1999) MR evaluation of the articular of the articular cartilage of the femoral head during traction. Correlation with resected femoral head. Acta Radiol 40:60–63
Neer CS (1990) Shoulder reconstruction. Saunders, Philadelphia, pp 298–276
Nehrer S, Spector M, Minas T (1999) Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop 365:149–162
Newman AP (1998) Articular cartilage. Am J Sports Med 2:309–324
O'Driscoll S, Fiztsimmons JS (2001) The role of periosteum in cartilage repair. Clin Orthop 391 [Suppl]:190–207
Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43:752–757
Peterson L, Minas T, Brittberg M, Nilsson A, Janssan E, Lindahl A (2000) Two to nine year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop 374:212–234
Pridie AH (1959) The method of resurfacing osteoarthritic joints. J Bone Joint Surg Br 41:618–623
Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460
Sgagliono NA, Miniaci A, Gillogly SD, Carter TR (2002) Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy 18:9–32
Simonian PT, Sussmann PS, Wickiewicz TL, Paletta GA, Warren RF (1998) Contact pressures at osteochondral donor sites in the knee. Am J Sports Med 26:491–494
Steadman JR, Rodkey WG, Singelton SB, Briggs KK (1997) Microfracture technique for full thickness chondral defects: technique and clinical results. Oper Techn Orthop 7:300–307
Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop 391 [Suppl]:362–269
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Siebold, R., Lichtenberg, S. & Habermeyer, P. Combination of microfracture and periostal-flap for the treatment of focal full thickness articular cartilage lesions of the shoulder: a prospective study. Knee Surg Sports Traumatol Arthrosc 11, 183–189 (2003). https://doi.org/10.1007/s00167-003-0363-x
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DOI: https://doi.org/10.1007/s00167-003-0363-x