Mid-term outcomes of microfracture for the treatment of focal, full-thickness cartilage defects isolated to the humeral head

Rony-Orijit Dey Hazra; Joan C Rutledge; Jared A Hanson; Maria E Dey Hazra; Marilee P Horan; Kent C Doan; Marco-Christopher Rupp; Peter J Millett

doi:10.1016/j.jse.2023.12.022

Mid-term outcomes of microfracture for the treatment of focal, full-thickness cartilage defects isolated to the humeral head

J Shoulder Elbow Surg. 2024 Feb 14:S1058-2746(24)00097-1. doi: 10.1016/j.jse.2023.12.022. Online ahead of print.

Authors

Rony-Orijit Dey Hazra¹, Joan C Rutledge², Jared A Hanson², Maria E Dey Hazra², Marilee P Horan², Kent C Doan³, Marco-Christopher Rupp⁴, Peter J Millett⁵

Affiliations

¹ Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
² Steadman Philippon Research Institute, Vail, CO, USA.
³ Steadman Philippon Research Institute, Vail, CO, USA; Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Orthopaedic Sports Medicine, Hospital rechts der Isar, Technical University of Munich, Munich, Germany; Kansas City Orthopedic Alliance, Kansas City, MO, USA.
⁴ Steadman Philippon Research Institute, Vail, CO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
⁵ Steadman Philippon Research Institute, Vail, CO, USA; Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. Electronic address: drmillett@thesteadmanclinic.com.

PMID: 38360353
DOI: 10.1016/j.jse.2023.12.022

Abstract

Background: While microfracture has been shown to be an effective treatment for chondral lesions in the knee, evidence to support its use for chondral defects in the shoulder is limited to short-term outcomes studies. The purpose of this study is to determine if microfracture provides pain relief and improved shoulder function in patients with isolated focal chondral defects of the humeral head at a minimum 5-year follow-up.

Methods: Patients who underwent microfracture procedure for isolated focal chondral defects of the humeral head with a minimum follow-up of 5 years between 02/2006 and 08/2016 were included. At minimum 5-year follow-up, pre- and postoperative patient-reported outcome (PRO) measures were collected, including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form-12 (SF-12) Physical Component Summary (PCS), Visual Analog Scale (VAS) for pain, and patient satisfaction level (1 = unsatisfied, 10 = very satisfied). Demographic, injury, and surgical data were retrospectively reviewed. Surgical failure was defined as revision surgery for humeral chondral defects or conversion to arthroplasty. Kaplan-Meier analysis was performed to determine survivorship at 5 years.

Results: A total of 17 patients met inclusion/exclusion criteria. There were 15 men and 2 women with an average age of 51 years (range 36-69) and an average follow-up of 9.4 years (range 5.0-15.8). The median ASES score improved from 62 (range: 22-88) preoperatively to 90 (range: 50-100) postoperatively (P = .011). Median satisfaction was 8 out of 10 (range: 2-10). There was no correlation between patient age or defect size and PROs. Postoperatively, patients reported significant improvements in recreational and sporting activity as well as the ability to sleep on the affected shoulder (P ≤ .05). Three patients failed and required revision surgery. The Kaplan-Meier analysis determined an overall survivorship rate of 80% at 5 years.

Conclusion: The presented study illustrates significant improvements for PROs, improved ability to perform recreational and sporting activities, and a survival rate of 80% at a mean of 9.4 years after microfracture for focal chondral humeral head defects.

Keywords: Shoulder arthroscopy; articular cartilage; cartilage defects; microfracture; shoulder; shoulder surgery.