Monday, December 31, 2012

Arthroscopic treatment of early glenohumeral arthritis

Arthroscopic treatment of early glenohumeral arthritis

It has long been hoped that a minimally invasive treatment for glenohumeral arthritis would be developed.

Here the authors report on 61 arthroscopies performed on patients aged 30-55 years with early glenohumeral arthritis. Arthroscopic circumferential capsulotomy was performed in all cases; glenoid chondral lesions were treated with microfractures; in 11 patients, an engineered hyaluronic acid membrane was placed on the surface of the glenoid.

The mean Constant score increased from 43.8 points to 79.1, and the mean Simple Shoulder Test score increased from 4.9 points to 9.4 points. Clinical outcomes improved significantly in 44 patients. Age, gender, glenohumeral distance, and presence of engineered hyaluronic acid membrane were not related to clinical scores. Recovery of range of motion and small and centered cartilage lesions were statistically associated with improved outcomes. Progression of symptomatic arthritis was seen in only three of these cases over two years.

The authors concluded that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions.

These results are of interest. They suggest that release of contracted soft tissues in shoulders with substantially preserved joint surfaces may be of benefit. It would be of interest to compare the results of physical therapy to this procedure in similar patients.


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