Summary

Microfracture of the glenohumeral joint for symptoamtic chondral defects can result in improved function and reduced pain, however, in this series, up to 25% of patients required conversion to arthroplasty less than 10 years following the index microfracture procedure.

Abstract

Background

Microfracture is an effective surgical treatment for isolated, full-thickness cartilage defects with current data focused on applications in the knee. Currently, only early outcomes are available analyzing patients undergoing microfracture in the glenohumeral joint. The purpose of this study is to present long-term clinical outcomes of patients undergoing microfracture of full-thickness articular cartilage defects of the glenohumeral joint.

Methods

A review of a consecutive series of patients who underwent arthroscopic microfracture of the humeral head and/or glenoid surface with a minimum follow-up of 7 years between 2001 and 2007 was conducted. All patients completed surveys containing the Simple Shoulder Test (SST), American Shoulder and Elbow Score (ASES), and visual analog scale (VAS) outcomes scores. Failure was defined by reoperation, including conversion to arthroplasty. Reoperation and failure rates were compared to a previous analysis of these patients at an average follow-up of 28 months.

Results

A total of 15 patients (16 shoulders) with an average age of 37.0±14.7 years (8 females, 7 males) were available for analysis at an average 9.3 ± 0.7 years following surgery (range, 8.5 to 10.5 years). The average size of humeral and glenoid defects was 5.07 cm2 (range, 1.0-7.8 cm2) and 1.66 cm2 (range, 0.4-3.8 cm2), respectively. Five patients (5 shoulders) underwent at least 1 reoperation, for an overall reoperation rate of 31%. Of these 5 patients, 4 underwent shoulder arthroplasty (2 initially, 2 after additional arthroscopic procedures) and were considered failures, for an overall failure rate of 25%. Of the patients who did not progress onto arthroplasty, there were statistically significant improvements in SST, VAS, and ASES outcomes scores compared to preoperative values. When compared to short-term follow-up at 28 months, in which 3 patients had already been considered failures, 1 additional patient progressed to failure at 9.6 years after the original microfracture.

Conclusions

The management of full-thickness symptomatic chondral defects of the glenohumeral joint is challenging. For some patients, microfracture can result in improved function and reduced pain, however, in this small series, up to 25% of patients required conversion to arthroplasty less than 10 years following the index microfracture procedure. Additional studies with larger patient cohorts are needed.