Nonarthroplasty treatment of glenohumeral cartilage lesions.
Treatment of young, active persons with symptomatic cartilage lesions of the glenohumeral joint represents a significant challenge. Diagnosis of glenohumeral chondral defects is not always straightforward and effective treatment requires familiarity with a number of techniques. Low-demand individuals may accept palliative therapy in the form of arthroscopic debridement as a temporizing solution. However, younger, high-demand individuals require a careful, stepwise approach that includes reparative, restorative, and reconstructive strategies. Reparative strategies use marrow-stimulation techniques to induce formation of fibrocartilage. Restorative tactics attempt to replace damaged cartilage with hyaline or hyaline-like tissue using osteochondral or chondrocyte transplantation. Large lesions that are not candidates for reparative or restorative procedures can be approached using reconstruction methods such as biologic resurfacing. This review examines causes of chondral injury in the glenohumeral joint, discusses diagnostic strategies, and presents a practical framework including palliative, reparative, restorative, and reconstructive options with which one can formulate a treatment plan for these patients.
McCarty
L Pearce
LP
Sports and Orthopaedic Specialists, Minneapolis, Minnesota, USA.
Cole
Brian J
BJ
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001178:Arthroplasty; D019643:Arthroplasty, Replacement; D001854:Bone Marrow Cells / Q000166:cytology; D002358:Cartilage, Articular / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D019902:Chondrocytes / Q000637:transplantation; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003646:Debridement; D050815:Fractures, Compression / Q000209:etiology / Q000628:therapy; D005944:Glucosamine / Q000627:therapeutic use; D006801:Humans; D051457:Hyaline Cartilage / Q000637:transplantation; D015994:Incidence; D007593:Joint Instability / Q000601:surgery / Q000628:therapy; D008279:Magnetic Resonance Imaging; D010166:Palliative Care; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D012783:Shoulder Dislocation / Q000628:therapy; D012784:Shoulder Fractures / Q000209:etiology / Q000628:therapy; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D014947:Wounds and Injuries / Q000534:rehabilitation
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002809:Chondroitin Sulfates; D005944:Glucosamine