Combination of microfracture and periostal-flap for the treatment of focal full thickness articular cartilage lesions of the shoulder: a prospective study

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 defe...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2003-05, Vol.11 (3), p.183-189
Main Authors: Siebold, R, Lichtenberg, S, Habermeyer, P
Format: Article
Language:English
Subjects:
Adolescent
Adult
Arthritis
Cartilage
Cartilage, Articular - injuries
Cartilage, Articular - pathology
Cartilage, Articular - surgery
Defects
Female
Humans
Magnetic resonance imaging
Male
Middle Aged
Orthopedic Procedures - methods
Osteoarthritis
Osteoarthritis - classification
Osteoarthritis - surgery
Outpatient care facilities
Pain - surgery
Patients
Periosteum - transplantation
Prospective Studies
Radiography
Range of Motion, Articular
Second-Look Surgery
Shoulder Joint - injuries
Shoulder Joint - pathology
Shoulder Joint - surgery
Surgery
Surgical Flaps
Titanium
Transplants & implants
Treatment Outcome
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Summary: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.
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-003-0363-x