2015 ISAKOS Biennial Congress ePoster #2312

Does Articular Cartilage Injury Affect Clinical Outcome Following Arthroscopic Stabilization for Glenohumeral Instability?

Aaron J. Krych, MD, Rochester, MN UNITED STATES
Paul L. Sousa, MBA, Rochester, MN UNITED STATES
Alexander Harrison King, BS, Rochester, MN UNITED STATES
Joseph A Morgan, MD, Rochester, MD UNITED STATES
Jedediah H. May, MD, Rochester, MN UNITED STATES
Diane L. Dahm, MD, Rochester, MN UNITED STATES

Mayo Clinic, Rochester, MN, USA

FDA Status Not Applicable

Summary: Glenohumeral instability has a high rate of cartilage injury with an increasing number of dislocations beign asscoiated with not only higher risk of chondral lesions, but higher grade lesions as well.

Rate:

Abstract:

Purpose

1) Determine the incidence of articular cartilage injuries for patients with instability of the glenohumeral (GH) joint, 2) determine if recurrent dislocators were at increased risk for articular damage and 3) correlate these injuries with postoperative clinical outcomes.

Methods

A cohort of consecutive patients who underwent diagnostic MRI and shoulder arthroscopy for glenohumeral instability from 1997-2006 at a single institution was identified. Exclusion criteria eliminated patients with moderate or severe osteoarthritis and those without documented history of dislocation or subluxation. Arthroscopic findings were recorded, including lesion location and Outerbridge grade. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to assess outcome. History of documented dislocation as well as increased number of dislocations were used as predictors of articular damage. Outcome was compared between shoulders with articular lesions and those without articular lesions.

Results

Eighty seven shoulders (83 patients) met the inclusion and exclusion criteria, with 69 (79%) males and 14 (16%) females, a mean age of 26.1 (range 18-64) years, and a mean follow-up of 36 months (range, 33-39). Cartilage injuries were detected in 56 shoulders (64%; 95% CI 0.53-0.73). Previously documented shoulder dislocation requiring closed reduction (p=0.046) and number of discrete dislocations (p=0.032) were significant for glenoid injury. A higher number of dislocations was associated with higher grade lesions of the glenohumeral joint (p < 0.001). Overall, mean ASES score was 89.6 (range 37-100). Among those with an articular cartilage lesion, the mean ASES score was 90.4 (range 58-100) compared to 88.1 (range 37-100; p=0.75).

Conclusions

Cartilage lesions were detected in 64% of the shoulders with GH instability, and increasing number of dislocations correlated with increased risk for high grade articular cartilage injury. While clinical outcome was not significantly affected, further investigation is warranted to establish a relationship between these injuries and longer-term outcomes.