This review examines the diagnosis and management of focal articular cartilage defects in the glenohumeral joint, a rare problem usually found incidentally alongside instability or trauma. It surveys nonsurgical and surgical options and assigns evidence-based treatment grades. The authors highlight how thin the supporting literature is for every strategy.
When you scope a shoulder for recurrent instability, actively inspect the cartilage. Two-thirds of these shoulders have chondral injury, and the more times the joint has dislocated, the higher the grade you will find. Start nonsurgically for isolated symptomatic defects: NSAIDs, therapy, and injections come first, though this rests on grade I (insufficient) evidence rather than proven benefit.
When surgery is needed, microfracture is the best-supported option (grade B) and can be done arthroscopically for contained full-thickness lesions. For larger or bipolar defects, autograft and allograft transplantation restore hyaline cartilage but require open approaches and carry only grade C support.
Remember two pitfalls: MRI misses many of these lesions (60% accuracy), and a history of intra-articular anesthetic pain pump use predicts both chondrolysis and worse allograft outcomes.
This review examines the diagnosis and management of focal articular cartilage defects in the glenohumeral joint, a rare problem usually found incidentally alongside instability or trauma. It surveys nonsurgical and surgical options and assigns evidence-based treatment grades. The authors highlight how thin the supporting literature is for every strategy.
When you scope a shoulder for recurrent instability, actively inspect the cartilage. Two-thirds of these shoulders have chondral injury, and the more times the joint has dislocated, the higher the grade you will find. Start nonsurgically for isolated symptomatic defects: NSAIDs, therapy, and injections come first, though this rests on grade I (insufficient) evidence rather than proven benefit.
When surgery is needed, microfracture is the best-supported option (grade B) and can be done arthroscopically for contained full-thickness lesions. For larger or bipolar defects, autograft and allograft transplantation restore hyaline cartilage but require open approaches and carry only grade C support.
Remember two pitfalls: MRI misses many of these lesions (60% accuracy), and a history of intra-articular anesthetic pain pump use predicts both chondrolysis and worse allograft outcomes.