The forces applied to the cartilage surfaces of the shoulder and elbow are generally lower than at the weightbearing joints of the lower extremities. Thus, focal chondral or osteochondral defects and early osteoarthritis are considerably less common than in the knee, hip or ankle.
Nonetheless, potentially clinically relevant focal defects can be found in over one fifth of patients with rotator cuff tears, impingement or general shoulder pain. The reasons for focal glenohumeral cartilage defects are manifold and include previous surgeries, trauma, osteochodritis dissecans, infections, avascular necrosis, rheumatoid arthritis, instabilities, or rotator cuff insufficiencies.
The symptoms of glenohumeral cartilage defects include stress-induced shoulder pain or pain at rest, limited sports performance, sharp pain or mechanical obstructions, or progressively increasing pain. However, symptoms are often unspecific and frequently do not allow to diagnose cartilage defects or gauge their significance in shoulder pain. Thus, the treatment of concomitant pathologies is a primary goal when glenohumeral cartilage defects are diagnosed and treated. As cartilage lesions around the shoulder are often an incidental finding and rarely occur in isolation, the influence on outcomes of treating concomitant pathhologies versus addressing cartilage defects is still controversial.
Various treatment options are available today, whereas overall results are very promising independent of chosen treatment modality. According to personal experience and scientific evidence, microfracturing is a simple but reliable treatment option, which leads to improvements of shoulder function and pain reduction. In contrast to microfracturing in the knee, results tend to remain stable even in the longterm. Similar to the knee, microfracturing is the first line treatment for focal, chondral defects of the glenohumeral joint under 2cm2. Larger chondral defects (2-6cm2) can be addressed with various forms of autologous chondrocyte transplantation. If there is bone involvement present (osteochondral lesions), osteochondral transfers from the humerus or knee provide a treatment option for defects <2.5cm2. Larger osteochondral lesions can be treated with partial humeral head resurfacing.
Around the elbow, focal chondral and osteochondral lesions are particularly common at the humeral capitulum in the context of an osteochondrosis dissecans in gymnasts and repetitive overhead or throwing athletes. Osteochondral lesions of the elbow also occur as the result of acute trauma or reduced joint congruency due to instability.
Contrary to the shoulder, microfracturing has not been as reliable around the elbow and has been associated with progressive degeneration and low return to sports rates. Thus, it should be reserved for small defects with limited symptoms when encountered as an incidental finding during arthroscopy for concomitant pathologies. For larger chondral lesions or osteochondral defects, autologous osteochondral transplantation - primarily using osteochondral plugs from the ipsilateral proximal femoral condyle - is the treatment option of choice. This has shown relatively good clinical and radiological results even in the longterm, while progression of degeneration seems to be slower compared to microfracturing. Furthermore, due to its anatomic characteristics and congruent nature of the elbow joint, treatment options are significantly influenced by the exact location of the defect. Treatment of concomitant pathologies (e.g. instabilities, plicae, loose bodies, etc.) and restoration of native joint mechanics are especially important at the elbow.