Summary
Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty
Abstract
Background
Glenohumeral instability represents a common cause of shoulder pain and disability among active-duty members of the military and is associated with the development of glenoid osteochondral defects; however, little data exist regarding clinical outcomes following combined arthroscopic glenoid microfracture and labral repair.
Purpose
To report clinical outcomes and survivorship following combined microfracture of isolated chondral lesions of the glenoid and labral repair among active patients less than 40 years of age. Additionally, we sought to compare outcomes with patients who underwent isolated shoulder stabilization procedures during the same time period.
Methods
All active-duty military patients under the age of 40 years who underwent simultaneous microfracture of chondral lesions of the glenoid and labral repair for shoulder instability between January 2011 and January 2017 with complete outcome scores were identified. Thirty-one patients met final inclusion criteria. Outcome scores were then compared with 209 patients who underwent shoulder stabilization without concomitant microfracture during the same time period.
Results
Thirty-one patients who underwent simultaneous labral repair and glenoid microfracture and 209 patients who underwent isolated shoulder stabilization procedures during the same time period were included. Average follow-up was 95.58+/-23.12 for microfracture patients and 83.38+/-25.93 for instability patients (p=0.014). All patients in the microfracture group were male with an average age of 31.90+/-6.28 years, which did not differ significantly from the instability cohort. The average size of the glenoid defect was 1.23 cm2+/-1.03 cm2. There were no complications and no patients progressed to further surgery in the microfracture group. Microfracture patients had statistically significant increases in the mean American Shoulder and Elbow Surgeons (ASES) score (46.13+/-10.15 vs. 79.90+/-13.87, p < .0001) and Single Assessment Numeric Evaluation (SANE) (46.61+/-19.08 vs. 79.13+/-14.43, p < .0001). Mean pain also decreased significantly as measured by the pain Visual Analogue Scale (VAS) (8.10+/-1.47 vs. 2.65+/-1.78, p < .0001). When compared to the instability cohort, microfracture patients had significantly worse postoperative ASES (89.03+/-14.28 vs 79.90+/-13.87, p=0.001), SANE (91.23+/-13.20 vs 79.13+/-14.43, p<0.0001), and VAS (1.55+/-1.92 vs 2.65+/-1.78, p=0.003) scores, as well as decreased range of motion in forward flexion (155.48+/-10.3 vs 151.29+/-11.76, p=0.039) and external rotation (65.17+/-0.64 vs 63.65+/-8.34, p=0.010). Fewer patients in the microfracture cohort met the SCB, PASS, or MOI for the ASES (p=0.0044, p=0.0035, p<0.0001), the PASS or MOI for the SANE (p<0.0001 and p<0.0001), or the PASS for the VAS (p=0.0001). At latest follow-up, only 58% of microfracture patients had returned to active-duty military service compared to 93.78% of isolated instability patients (p<0.0001).
Conclusion
Isolated glenoid osteochondral defects remain a challenging pathology to treat. Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty However, only 58% of patients were able to maintain active-duty military service at midterm follow up compared to 93.78% of patients who underwent labral repair without concomitant microfracture.