ICL 207 Glenhumeral Arthritis in the Young Patient: Arthroscopic and Other Options-Millett Handout

Millett Handout

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This presentation by Dr. Peter J. Millett addresses joint preservation strategies for young, active patients with shoulder osteoarthritis (OA), focusing on alternatives to total shoulder arthroplasty (TSA), which has limitations in younger populations due to implant longevity, higher revision complication rates, and potentially suboptimal outcomes.<br /><br />Key challenges include identifying appropriate patients who suffer pain and understanding their expectations. Arthroscopic approaches aim to alleviate pain by addressing pathologies like synovitis, loose bodies, capsular contracture, biceps tendinitis, and axillary nerve compression.<br /><br />Microfracture is presented as a technique to promote cartilage repair in focal full-thickness chondral defects by inducing mesenchymal cell proliferation. Studies demonstrate good clinical improvement in most patients, especially with smaller lesions, although long-term repair durability requires further investigation.<br /><br />Debridement procedures involve removing irritants such as loose bodies and osteophytes, combined with capsular release and limited microfracture. These provide symptom relief and improved range of motion but are less effective in advanced OA. Outcomes vary, and progression to arthroplasty can occur with severe degeneration or reduced joint space.<br /><br />The Comprehensive Arthroscopic Management (CAM) procedure integrates osteophyte removal, subacromial decompression, capsular release, axillary neurolysis, and biceps tenodesis to restore function and relieve pain, with reported 85% two-year survival free of arthroplasty and significant improvements in functional scores. Success predictors include larger joint space (>2mm), specific glenoid morphology, and lower OA grade.<br /><br />Other emerging biological options include autologous cartilage transplantation, biologic resurfacing with all-arthroscopic techniques, osteochondral allografts (including medial tibial plateau grafts), and partial prosthetic replacements for focal lesions.<br /><br />Dr. Millett’s treatment algorithm recommends microfracture for focal chondral defects, fresh osteochondral allografts for focal osteochondral lesions, arthroscopic joint preservation (CAM) for diffuse degenerative changes, and TSA reserved for more advanced disease.<br /><br />In summary, multiple joint-preserving arthroscopic and biological strategies can delay or prevent arthroplasty in young, active patients with shoulder OA, tailored to lesion size, severity, and patient factors, aiming for symptom relief and maintained function.

Keywords

shoulder osteoarthritis

joint preservation

total shoulder arthroplasty

arthroscopic management

microfracture technique

debridement procedures

Comprehensive Arthroscopic Management (CAM)

biological treatment options

osteochondral allografts

treatment algorithm