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I work for an orthopedic surgeon as a surgical tech. I like to keep up with the latest techniques. Lately, we've been seeing a lot of younger, active patients with damage to the joint surface of the shoulder (very similar to knee problems we see). Can these shoulder cartilage problems be treated the same as knee chondral (cartilage) defects?
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This is a question under close scrutiny in the research world that deals with orthopedic problems. A recent article from surgeons at the Center for Shoulder, Elbow, and Sports Medicine at Columbia University Medical Center in New York City may shed some light on what's happening in this area. The authors review alternate treatment approaches for glenohumeral arthrosis (damage to the shoulder joint). The term "alternate" refers to some other way to solve the problem without a shoulder replacement.
There are restorative procedures that can be done to help the joint cartilage heal and recover. Smaller lesions can be treated with abrasion, microfracture, and drilling techniques. Larger holes and defects may respond better to grafting procedures. Grafting uses cartilage and subchondral bone (first layer of bone under the cartilage) from the patient or from a donor to fill in the hole and stimulate bone and chondral growth around the defect.
The decision about which restorative approach to use is very complex. All of the treatments just mentioned for restorative care of the shoulder cartilage are being used and studied primarily in the knee. Their use for the shoulder is just beginning.
There is a different management approach already in use for a case of shoulder arthrosis that is not quite ready for replacement. This is called joint resurfacing. The damaged head of the humerus (upper arm bone) is shaved down and covered with a metal cap. This is similar to putting a cap on a tooth. Results of resurfacing in young, active patients have been very favorable so far. Loosening of the metal cap is the number one problem to develop.
For patients with large defects, another new idea is the focal humeral resurfacing implant. The device looks like a large screw with a smooth head. It is screwed into the head of the humerus and provides a smooth surface to slide and glide in the joint.
Resurfacing of the shoulder joint can be done without a metal cap or implant. Surgeons are experimenting with various soft tissues to use as a covering. This technique is referred to as biologic interposition. The Achilles tendon from behind the heel is the most popular graft tissue for this treatment but others are being tried.
The use of knee cartilage (called the meniscus) to cover chondral defects in the shoulder has moved from cadaver studies to live humans. The meniscus has the right shape (round) and is flexible enough to conform to the joint surface. Concerns about complications and lack of durability have delayed routine use of this procedure.
And finally, there is a movement in the scientific world to find a way to engineer chondral (cartilage) tissue. This technique is called regenerative tissue or biologic resurfacing. Some experts really see this as the future of medicine for worn out parts and places anywhere in the body, including the joint cartilage.
As you can see from this report, there are many treatment options for shoulder chondral lesions that are being developed and studied. Not all are currently available or available routinely. In time, researchers will sort out which patients are good candidates for each procedure. If and when restoration of the joint surface just isn't possible, then a partial or complete joint replacement can be considered.
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