Purpose
The purpose of this systematic review was to evaluate the reported outcomes of joint-preserving surgical procedures in patients with focal chondral lesions of the glenohumeral joint.
Methods
A comprehensive literature search was conducted using PubMed, Embase, and Medline. Patients were included if they underwent a joint-preserving surgical procedure to treat a focal chondral defect of the glenoid, humeral head or both. Patients were excluded if they were being treated for a diffuse cartilage defect, or if they were treated with a shoulder arthroplasty. Study characteristics, patient demographics, and outcome data were collected.
Results
Ten studies were included in this review, with follow-up data available for 194 shoulders in 191 patients. Eight types of joint-preserving surgical procedures were evaluated, with microfracture being the most commonly used. Patient-reported and functional outcomes were reported in all studies. One study evaluating microfracture reported significant improvements in VAS, ASES, and SST scores at both short-term (VAS: P = .003; ASES: P = .006; SST: P = .009) and long-term (VAS: P = .007; ASES: P = .014; SST: P = .009) follow-up when compared to preoperative scores. Across all studies, a total of 32 patients (16%) underwent subsequent shoulder surgery, with 22 (69%) of these reoperations being shoulder arthroplasties.
Conclusions
The findings of this systematic review demonstrate improvements in patient-reported and functional outcomes across all studies. Although joint-preserving procedures have shown reasonable outcomes for focal chondral defects of the GH joint, their long-term outcomes are still unknown. Progression of OA remains a concern that should be discussed with this patient population. Future studies with higher quality evidence are required to make definitive recommendations.