03 May Arthroscopy & Shoulder Injuries
Outcomes of full-thickness articular cartilage injuries of the shoulder treated with microfracture.
Millett PJ, Huffard BH, Horan MP, Hawkins RJ, Steadman JR
PURPOSE: The purpose of this study was to determine whether microfracture provides pain relief and improves shoulder function in patients with chondral defects of the glenohumeral joint.
METHODS: Microfracture was performed in glenohumeral joints with full-thickness chondral lesions. Concomitant procedures were performed as indicated. Patients aged 60 years or older and those with complete rotator cuff tears were excluded. We included 31 shoulders in 30 patients in this study. Included were 25 men and 5 women with a mean age of 43 years (range, 19 to 59 years). Of the 31 surgeries, 6 (19%) progressed to another surgery. Subjective data obtained at a minimum of 2 years’ follow-up were available in 24 patients (25 shoulders). Patient pain and functional outcomes were measured by use of the American Shoulder and Elbow Surgeons (ASES) score and patient satisfaction. Data were analyzed by use of paired t tests and regression analysis.
RESULTS: The mean follow-up was 47 months (range, 25 to 128 months). The mean pain scores decreased from 3.8 to 1.6 postoperatively (0, no pain; 10, worst pain). The patients’ ability to work, activities of daily living, and sports activity significantly improved postoperatively (P < .05). Painless use of the involved arm improved postoperatively (P < . 05). The mean ASES score improved by 20 points over the preoperative score (P < .05). Mean satisfaction with surgical outcome was 7.6 of 10. There was no association between age or gender and surgical outcomes. The greatest improvements were seen in patients who had microfracture of isolated lesions of the humerus.
CONCLUSIONS: Failure occurred in 6 of the 31 shoulders (19%). In the remaining patients there was a significant improvement of 20 points (range, -11 to 45 points) in the ASES score compared with preoperatively. In those patients in whom just the humerus was treated, the greatest improvement was seen, with an increase of 32 points (range, 3 to 87 points). There was a negative correlation between the size of the lesion and ASES improvement (r = -0.351, P = .12). Our data showed the greatest improvement for smaller lesions of the humerus with the worst results in patients with bipolar lesions.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PMID: 19664505 [PubMed – indexed for MEDLINE]