Skip to main content

Nontraumatic Shoulder Osteochondral Defects

  • Chapter
  • First Online:
Joint Function Preservation

Abstract

Atraumatic chondral lesions of the glenohumeral are not common disorders, but it is beyond any question that such patients remain a challenge for the shoulder surgeon. Lack of algorithms and scant available data may increase the difficulty in providing state-of-art treatment. Therefore, in this chapter, a brief summary of the etiology and diagnostic process of the chondral glenohumeral joint lesions is described and followed by a throughout descriptive review of the up-to-date conservative and surgical treatment options.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Patzer T, Lichtenberg S, Kircher J, Magosch P, Habermeyer P. Influence of SLAP lesions on chondral lesions of the glenohumeral joint. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):982–7.

    Article  PubMed  Google Scholar 

  2. Provencher MT, Barker JU, Strauss EJ, Frank RM, Romeo AA, Matsen FA, et al. Glenohumeral arthritis in the young adult. Instr Course Lect. 2011;60:137–53.

    PubMed  Google Scholar 

  3. 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(4):e519–22.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Saltzman BM, Leroux T, Cole BJ. Management and surgical options for articular defects in the shoulder. Clin Sports Med. 2017;36(3):549–72.

    Article  PubMed  Google Scholar 

  5. Frank RM, Van Thiel GS, Slabaugh MA, Romeo AA, Cole BJ, Verma NN. Clinical outcomes after microfracture of the glenohumeral joint. Am J Sports Med. 2010;38(4):772–81.

    Article  PubMed  Google Scholar 

  6. Paley KJ, Jobe FW, Pink MM, Kvitne RS, ElAttrache NS. Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy. 2000;16(1):35–40.

    Article  PubMed  CAS  Google Scholar 

  7. Guntern DV, Pfirrmann CWA, Schmid MR, Zanetti M, Binkert CA, Schneeberger AG, et al. Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome. Radiology. 2003;226(1):165–70.

    Article  PubMed  Google Scholar 

  8. Seidl AJ, Kraeutler MJ. Management of articular cartilage defects in the glenohumeral joint. J Am Acad Orthop Surg. 2018;26(11):e230–7.

    Article  PubMed  Google Scholar 

  9. Lunden JB, Legrand AB. Osteochondritis dissecans of the humeral head. J Orthop Sports Phys Ther. 2012;42(10):886.

    Article  PubMed  Google Scholar 

  10. Mima Y, Matsumura N, Ogawa K, Iwamoto T, Ochi K, Sato K, et al. Osteochondritis dissecans on the medial aspect of the humeral head. Int J Shoulder Surg. 2016;10(2):89–91.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cooper C, Steinbuch M, Stevenson R, Miday R, Watts NB. The epidemiology of osteonecrosis: findings from the GPRD and THIN databases in the UK. Osteoporos Int. 2010;21(4):569–77.

    Article  PubMed  CAS  Google Scholar 

  12. Lee JA, Farooki S, Ashman CJ, Yu JS. MR patterns of involvement of humeral head osteonecrosis. J Comput Assist Tomogr. 2002;26(5):839–42.

    Article  PubMed  Google Scholar 

  13. Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury. 2016;47:S16–26.

    Article  PubMed  Google Scholar 

  14. Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med. 2015;8(3):201–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hasan SS, Romeo AA. Nontraumatic osteonecrosis of the humeral head. J Shoulder Elb Surg. 2002;11(3):281–98.

    Article  Google Scholar 

  16. Mont MA, Payman RK, Laporte DM, Petri M, Jones LC, Hungerford DS. Atraumatic osteonecrosis of the humeral head. J Rheumatol. 2000;27(7):1766–73.

    PubMed  CAS  Google Scholar 

  17. Hernigou P, Flouzat-Lachaniette C-H, Roussignol X, Poignard A. The natural progression of shoulder osteonecrosis related to corticosteroid treatment. Clin Orthop Relat Res. 2010;468(7):1809–16.

    Article  PubMed  Google Scholar 

  18. Fox JA, Cole BJ, Romeo AA, Meininger AK, Williams JM, Glenn RE, et al. Articular cartilage thickness of the humeral head: an anatomic study. Orthopedics. 2008;31(3):216.

    Article  PubMed  Google Scholar 

  19. Bicos J, Mazzocca A, Romeo AA. The glenoid center line. Orthopedics. 2005;28(6):581–5.

    Article  PubMed  Google Scholar 

  20. Snow M, Funk L. Microfracture of chondral lesions of the glenohumeral joint. Int J Shoulder Surg. 2008;2(4):72–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gross CE, Chalmers PN, Chahal J, Van Thiel G, Bach BR, Cole BJ, et al. Operative treatment of chondral defects in the glenohumeral joint. Arthroscopy. 2012;28(12):1889–901.

    Article  PubMed  Google Scholar 

  22. Johnson DL, Warner JJ. Osteochondritis dissecans of the humeral head: treatment with a matched osteochondral allograft. J Shoulder Elb Surg. 1997;6(2):160–3.

    Article  CAS  Google Scholar 

  23. Romeo AA, Cole BJ, Mazzocca AD, Fox JA, Freeman KB, Joy E. Autologous chondrocyte repair of an articular defect in the humeral head. Arthroscopy. 2002;18(8):925–9.

    Article  PubMed  Google Scholar 

  24. McCarty LP, Cole BJ. Nonarthroplasty treatment of glenohumeral cartilage lesions. Arthroscopy. 2005;21(9):1131–42.

    Article  PubMed  Google Scholar 

  25. Ellman H, Harris E, Kay SP. Early degenerative joint disease simulating impingement syndrome: arthroscopic findings. Arthroscopy. 1992;8(4):482–7.

    Article  PubMed  CAS  Google Scholar 

  26. Kang RW, Frank RM, Nho SJ, Ghodadra NS, Verma NN, Romeo AA, et al. Complications associated with anterior shoulder instability repair. Arthroscopy. 2009;25(8):909–20.

    Article  PubMed  Google Scholar 

  27. Denti M, Monteleone M, Trevisan C, De Romedis B, Barmettler F. Magnetic resonance imaging versus arthroscopy for the investigation of the osteochondral humeral defect in anterior shoulder instability. A double-blind prospective study. Knee Surg Sports Traumatol Arthrosc. 1995;3(3):184–6.

    Article  PubMed  CAS  Google Scholar 

  28. Potter HG, Chong LR. Magnetic resonance imaging assessment of chondral lesions and repair. J Bone Joint Surg Am. 2009;91(Suppl 1):126–31.

    Article  PubMed  Google Scholar 

  29. Cruess RL. Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip. Clin Orthop Relat Res. 1978;130:86–93.

    Google Scholar 

  30. Hünnebeck SM, Magosch P, Habermeyer P, Loew M, Lichtenberg S. Chondral defects of the glenohumeral joint: long-term outcome after microfracturing of the shoulder. Obere Extrem. 2017;12(3):165–70.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;85-A(Suppl 2):58–69.

    Article  Google Scholar 

  32. Bhatia DN, van Rooyen KS, du Toit DF, et al. Arthroscopic technique of interposition arthroplasty of the glenohumeral joint. Arthroscopy. 2006;22:570.e1–5.

    Article  Google Scholar 

  33. Dacre JE, Beeney N, Scott DL. Injections and physiotherapy for the painful stiff shoulder. Ann Rheum Dis. 1989;48(4):322–5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Paik J, Duggan ST, Keam SJ. Triamcinolone acetonide extended-release: a review in osteoarthritis pain of the knee. Drugs. 2019;79(4):455–62.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Kraus V, Conaghan P, Aazami H, Mehra P, Kivitz A, Lufkin J, Hauben J, Johnson J, Bodick N. Synovial and systemic pharmacokinetics (PK) of triamcinolone acetonide (TA) following intra-articular (IA) injection of an extended-release microsphere-based formulation (FX006) or standard crystalline suspension in patients with knee osteoarthritis (OA). Osteoarthr Cartil. 2018;26:34–42.

    Article  CAS  Google Scholar 

  36. Kreuz PC, Steinwachs M, Angele P. Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature. Knee Surg Sports Traumatol Arthrosc. 2017;26:819–30.

    Article  PubMed  Google Scholar 

  37. Jayaram P, Kennedy DJ, Yeh P, Dragoo J. Chondrotoxic effects of local anesthetics on human knee articular cartilage: a systematic review. PM R. 2019;11(4):379–400.

    Article  PubMed  Google Scholar 

  38. Van Thiel GS, Sheehan S, Frank RM, Slabaugh M, Cole BJ, Nicholson GP, et al. Retrospective analysis of arthroscopic management of glenohumeral degenerative disease. Arthroscopy. 2010;26(11):1451–5.

    Article  PubMed  Google Scholar 

  39. Millett PJ, Horan MP, Pennock AT, Rios D. Comprehensive arthroscopic management (CAM) procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis. Arthroscopy. 2013;29(3):440–8.

    Article  PubMed  Google Scholar 

  40. Mook WR, Petri M, Greenspoon JA, Millett PJ. The comprehensive arthroscopic management procedure for treatment of Glenohumeral osteoarthritis. Arthrosc Tech. 2015;4(5):e435–41.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mitchell JJ, Warner BT, Horan MP, Raynor MB, Menge TJ, Greenspoon JA, et al. Comprehensive arthroscopic management of glenohumeral osteoarthritis: preoperative factors predictive of treatment failure. Am J Sports Med. 2017;45(4):794–802.

    Article  PubMed  Google Scholar 

  42. Mitchell JJ, Horan MP, Greenspoon JA, Menge TJ, Tahal DS, Millett PJ. Survivorship and patient-reported outcomes after comprehensive arthroscopic management of glenohumeral osteoarthritis: minimum 5-year follow-up. Am J Sports Med. 2016;44(12):3206–13.

    Article  PubMed  Google Scholar 

  43. Kerr BJ, McCarty EC. Outcome of arthroscopic débridement is worse for patients with glenohumeral arthritis of both sides of the joint. Clin Orthop Relat Res. 2008;466(3):634–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Skelley NW, Namdari S, Chamberlain AM, Keener JD, Galatz LM, Yamaguchi K. Arthroscopic debridement and capsular release for the treatment of shoulder osteoarthritis. Arthroscopy. 2015;31(3):494–500.

    Article  PubMed  Google Scholar 

  45. Cameron BD, Galatz LM, Ramsey ML, et al. Non-prosthetic management of grade IV osteochondral lesions of the glenohumeral joint. J Shoulder Elb Surg. 2002;11(1):25–32.

    Article  Google Scholar 

  46. Steadman JR, Rodkey WG, Briggs KK, Rodrigo JJ. [The microfracture technic in the management of complete cartilage defects in the knee joint]. Orthopade. 1999;28(1):26–32.

    Google Scholar 

  47. Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):1986–96.

    Article  PubMed  Google Scholar 

  48. Millett PJ, Huffard BH, Horan MP, Hawkins RJ, Steadman JR. Outcomes of full-thickness articular cartilage injuries of the shoulder treated with microfracture. Arthroscopy. 2009;25:856–63.

    Article  PubMed  Google Scholar 

  49. Mithoefer K, Williams RJ 3rd, Warren RF, et al. Chondral resurfacing of articular cartilage defects in the knee with microfracture technique. Surgical technique. J Bone Joint Surg Am. 2006;68(Suppl 1, Pt):294–304.

    Article  Google Scholar 

  50. Slabaugh MA, Frank RM, Cole BJ. Resurfacing of isolated articular cartilage defects in the glenohumeral joint with microfracture: a surgical technique & case report. Am J Orthop. 2010;39(7):326–32.

    PubMed  Google Scholar 

  51. 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. 2003;11(3):183–9.

    Article  PubMed  CAS  Google Scholar 

  52. Scheibel M, Bartl C, Magosch P, Lichtenberg S, Habermeyer P. Osteochondral autologous transplantation for the treatment of full-thickness articular cartilage defects of the shoulder. J Bone Joint Surg Br. 2004;86(7):991–7.

    Article  PubMed  CAS  Google Scholar 

  53. Fox JA, Cole BJ, Pylawka TK, Romeo AA. Chapter 20: cartilage injuries in the shoulder. In: Cartilage injury in the athlete. New York, NY: Thieme Medical Publishers; 2006. p. 217–31.

    Google Scholar 

  54. Park T-S, Kim T-S, Cho J-H. Arthroscopic osteochondral autograft transfer in the treatment of an osteochondral defect of the humeral head: report of one case. J Shoulder Elb Surg. 2006;15(6):e31–6.

    Article  Google Scholar 

  55. Gobezie R, Lenarz CJ, Wanner JP, Streit JJ. All-arthroscopic biologic total shoulder resurfacing. Arthroscopy. 2011;27(11):1588–93.

    Article  PubMed  Google Scholar 

  56. Provencher MT, Barker JU, Strauss EJ, Frank RM, Romeo AA, Matsen FA, et al. Glenohumeral arthritis in the young adult. Instr Course Lect. 2011;60:137–53.

    PubMed  Google Scholar 

  57. Saltzman BM, Riboh JC, Cole BJ, Yanke AB. Humeral head reconstruction with osteochondral allograft transplantation. Arthroscopy. 2015;31(9):1827–34.

    Article  PubMed  Google Scholar 

  58. Mistry H, Metcalfe A, Smith N, Loveman E, Colquitt J, Royle P, et al. The cost-effectiveness of osteochondral allograft transplantation in the knee. Knee Surg Sports Traumatol Arthrosc. 2019;27(6):1739–53.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Pallante AL, Bae WC, Chen AC, Görtz S, Bugbee WD, Sah RL. Chondrocyte viability is higher after prolonged storage at 37 degrees C than at 4 degrees C for osteochondral grafts. Am J Sports Med. 2009;37(Suppl 1):24S–32S.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Görtz S, Bugbee WD. Fresh osteochondral allografts: graft processing and clinical applications. J Knee Surg. 2006;19(3):231–40.

    Article  PubMed  Google Scholar 

  61. Camp CL, Barlow JD, Krych AJ. Transplantation of a tibial osteochondral allograft to restore a large glenoid osteochondral defect. Orthopedics. 2015;38(2):e147–52.

    Article  PubMed  Google Scholar 

  62. Buchmann S, Salzmann GM, Glanzmann MC, Wörtler K, Vogt S, Imhoff AB. Early clinical and structural results after autologous chondrocyte transplantation at the glenohumeral joint. J Shoulder Elb Surg. 2012;21(9):1213–21.

    Article  Google Scholar 

  63. Harreld KL, Marulanda GA, Ulrich SD, Marker DR, Seyler TM, Mont MA. Small-diameter percutaneous decompression for osteonecrosis of the shoulder. Am J Orthop. 2009;38(7):348–54.

    PubMed  Google Scholar 

  64. LaPorte DM, Mont MA, Mohan V, Pierre-Jacques H, Jones LC, Hungerford DS. Osteonecrosis of the humeral head treated by core decompression. Clin Orthop Relat Res. 1998;355:254–60.

    Article  Google Scholar 

  65. Mont MA, Maar DC, Urquhart MW, Lennox D, Hungerford DS. Avascular necrosis of the humeral head treated by core decompression. A retrospective review. J Bone Joint Surg Br. 1993;75(5):785–8.

    Article  PubMed  CAS  Google Scholar 

  66. L’Insalata JC, Pagnani MJ, Warren RF, Dines DM. Humeral head osteonecrosis: clinical course and radiographic predictors of outcome. J Shoulder Elb Surg. 1996;5(5):355–61.

    Article  Google Scholar 

  67. Kennon JC, Smith JP, Crosby LA. Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head. J Shoulder Elb Surg. 2016;25(9):1442–8.

    Article  Google Scholar 

  68. Scalise J, Miniaci A, Iannotti J. Resurfacing arthroplasty of the humerus: indications, surgical technique, and clinical results. Tech Shoulder Elb Surg. 2007;8(3):152–60.

    Article  Google Scholar 

  69. Sweet SJ, Takara T, Ho L, Tibone JE. Primary partial humeral head resurfacing: outcomes with the HemiCAP implant. Am J Sports Med. 2015;43(3):579–87.

    Article  PubMed  Google Scholar 

  70. Uribe JW, Botto-van BA. Partial humeral head resurfacing for osteonecrosis. J Shoulder Elb Surg. 2009;18(5):711–6.

    Article  Google Scholar 

  71. Ranalletta M, Bertona A, Tanoira I, Rossi LA, Bongiovanni S, Maignón GD. Results of partial resurfacing of humeral head in patients with avascular necrosis. Rev Esp Cir Ortop Traumatol. 2019;63(1):29–34.

    CAS  Google Scholar 

  72. Cvetanovich GL, Naylor AJ, O’Brien MC, Waterman BR, Garcia GH, Nicholson GP. Anatomic total shoulder arthroplasty with an inlay glenoid component: clinical outcomes and return to activity. J Shoulder Elb Surg. 2020;29(6):1188–96.

    Article  Google Scholar 

  73. Egger AC, Peterson J, Jones MH, Miniaci A. Total shoulder arthroplasty with nonspherical humeral head and inlay glenoid replacement: clinical results comparing concentric and nonconcentric glenoid stages in primary shoulder arthritis. JSES Open Access. 2019;3(3):145–53.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Franceschi F, Franceschetti E, Paciotti M, Torre G, Samuelsson K, Papalia R, et al. Surgical management of osteonecrosis of the humeral head: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3270–8.

    Article  PubMed  Google Scholar 

  75. Hattrup SJ, Cofield RH. Osteonecrosis of the humeral head: results of replacement. J Shoulder Elb Surg. 2000;9(3):177–82.

    Article  CAS  Google Scholar 

  76. Feeley BT, Fealy S, Dines DM, Warren RF, Craig EV. Hemiarthroplasty and total shoulder arthroplasty for avascular necrosis of the humeral head. J Shoulder Elb Surg. 2008;17(5):689–94.

    Article  Google Scholar 

  77. Ristow JJ, Ellison CM, Mickschl DJ, Berg KC, Haidet KC, Gray JR, et al. Outcomes of shoulder replacement in humeral head avascular necrosis. J Shoulder Elb Surg. 2019;28(1):9–14.

    Article  Google Scholar 

  78. Navarro SM, Haeberle HS, Khlopas A, Newman JM, Karnuta JM, Mont MA, Ramkumar PN. Short-term outcomes after anatomic total shoulder arthroplasty in patients with osteoarthritis versus osteonecrosis. Ann Transl Med. 2019;7:48.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Tyrrell Burrus M, Cancienne JM, Boatright JD, Yang S, Brockmeier SF, Werner BC. Shoulder arthroplasty for humeral head avascular necrosis is associated with increased postoperative complications. HSS J. 2018;14(1):2–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sibilska, A., Herman, K., Kwapisz, A. (2022). Nontraumatic Shoulder Osteochondral Defects. In: Gobbi, A., Lane, J.G., Longo, U.G., Dallo, I. (eds) Joint Function Preservation. Springer, Cham. https://doi.org/10.1007/978-3-030-82958-2_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-82958-2_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-82957-5

  • Online ISBN: 978-3-030-82958-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics