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Abstract Presented at the 29th Annual Meeting of the Arthroscopy Association of North America| Volume 26, ISSUE 6, SUPPLEMENT , e11-e12, June 01, 2010

Arthroscopic Debridement and Capsular release of the Shoulder as a Treatment for Osteoarthritis of the Glenohumeral Joint (SS-22)

      Introduction

      In patients with osteoarthritis of the shoulder that have failed conservative treatment surgical treatment is an option. The surgical options available are total shoulder arthroplasty hemi-arthroplasty and resurfacing arthroplasty. Another alternative surgical option is an arthroscopic debridement and capsular release of the shoulder. We have been performing an arthroscopic debridement and capsular release at our institute as an alternative for patients not willing to undergo shoulder arthroplasty

      Methods

      We present a retrospective case series of 29 patients(32 shoulders, 3 bilateral)who underwent arthroscopic debridement of the shoulder for osteoarthritis. The patients were operated on between January 2001 - December 2008.The primary indication for the procedure was pain and stiffness. Many of the patients were offered and had refused a shoulder replacement or resurfacing procedure prior to presenting to our institute. In 24 of the 32 shoulders an auxiliary posterior portal was used which helped in excising osteophytes fro the inferior humeral head neck junction (“goat's beard”). Chondromalacia was graded on the Outerbridge grading scale, on either side of the glenohumeral joint and ranged from grade 2 to 4, with the median grade being grade 4 and the mean 3.7. Patients were examined pre and post operatively at 3 months, 6 months,1 year and the last follow up recorded. The average follow-up was 40 months. At each of these visits the Constant score was recorded, as was the Pain score and Activities of Daily Living (ADL) score.

      Results

      The mean preoperative constant score was 11.36.The mean post operative constant score was 26.29, with a gain of 15 points on the Constant score. The mean preoperative Forward flexion was 123.7 degrees which improved to 133 degrees. The mean preoperative Abduction was 92.6 degrees which improved to 115 degrees, an average gain of 22.4 degrees. The mean preoperative External rotation was 25 degrees which improved to 58 degrees, an average gain of 33 degrees. The mean preoperative Internal rotation was 12 degrees which improved to 40 degrees, a gain of 28 degrees. The preoperative pain score was 3, which improved to 10 on a 15 point scale (15 no pain). The preoperative ADL Score was 2.55, which improved to 6.27 on 20 point scale (20 normal ADLs).

      Conclusion

      On analyzing this series of patients our conclusion is that arthroscopic debridement of the shoulder has a role to play in the management of osteoarthritis of the glenohumeral joint. The most improvement was in regaining external rotation, decreasing pain which has been maintained at 40 months and improvement in the ability to perform ADLs This seems to be a viable alternative in the short term follow-up, a longer term study is needed.