Microfracture (Mcfx) has been an effective treatment for chondral lesions in the knee, but there is little evidence to support its use for chondral defects in the shoulder. The best treatment for articular cartilage defects in the shoulder remains unknown. The purpose of this study was to determine the pain and functional outcomes after microfracture in shoulder. The Mcfx procedure can improve function and pain in shoulders with symptomatic, full thickness chondral defects.
Mcfx was performed in shoulders with full thickness chondral lesions of the glenohumeral joint. Concomitant procedures for synovitis, loose bodies, partial cuff tear debridment, acromioplasty and instability were performed as indicated. Patients over 60 years of age and those with complete rotator cuff tears were excluded. Excluded from follow-up were 6 subjects that had subsequent surgery which were considered failures and 2 patients that died. Eighteen patients had two year subjective follow-up. Included were 16 men and 2 women with an average age of 45 years (range 24-59). Patient’s pain and functional outcomes were measures using the American Shoulder and Elbow Surgeon Score (ASES) and patient satisfaction level (1 = unsatisfied, 10 = very satisfied). Data were analyzed using paired t-tests and regression analysis.
Average follow-up was 40 months (range 25 – 67). Mean pain scores decreased from 3.6 preoperatively to 1.3 postoperatively (0 = no pain, 10 = worst pain). Patients’ ability to work, ADL and sports activity had a significant improvement postoperatively (p < 0.05). Patient’s painless use of their arm improved postoperatively (p < 0.05). The average ASES score improved from 61 preoperatively to 82 postoperatively (p < 0.05). Average satisfaction with surgical outcome was 7.8 out of 10. There was an association with age at surgery and satisfaction with outcomes but not the ASES score. Patient’s pain and function improved significantly postoperatively (p < 0.05). Half of the patients were involved in sports and report their ability to compete improved significantly postoperatively (p < 0.05).
The best treatment for articular cartilage defects in the shoulder remains unknown. Mcfx has been shown to be an effective treatment option for cartilage injuries in the knee. Outcomes after Mcfx in the shoulder have not been well studied. Our study shows that patients have less pain and improved shoulder function after surgical intervention, which included a Mcfx procedure. The Mcfx procedure can improve function and pain in shoulders with symptomatic, full thickness chondral defects.
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.