Full Answer
What are the treatment options for chondral injurys?
Treatment Until the final diagnosis is made, your physician may prescribe anti-inflammatory medication and rest to relieve symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended. In many cases, nonsurgical methods are effective in relieving symptoms and healing the injured structures.
What is the best treatment for osteochondral lesion of the shoulder?
May 25, 2012 · Non-arthroplasty options in the management of glenohumeral chondral lesions include palliative (debridement), reparative (microfracture/abrasion chondroplasty), restorative (ACI/MACI and osteochondral allograft and autograft transfer), and reconstructive (interposition arthroplasty and prosthetic resurfacing) procedures.
What are chondral lesions in shoulder arthroscopy?
Oct 01, 2006 · Reparative procedures such as abrasion chondroplasty, drilling, or microfracture attempt to elicit formation of a fibrocartilaginous repair tissue through stimulation of marrow elements. Originally developed for the treatment of chondral defects in the knee, microfracture has more recently been applied in the shoulder as well.
What is the workup for chondral lesions of the glenohumeral?
Aug 22, 2017 · Once a symptomatic chondral lesion has been identified, a trial of non-operative therapy is warranted, including ice, nonsteroidal anti-inflammatory medications, and physical therapy. Therapy with a focus on strengthening of the periscapular musculature and rotator cuff may be particularly effective to address any concomitant scapular dyskinesis.
How is chondral loss treated?
The treatment for chondral injurys ranges from conservative, to arthroscopic and open surgeries (arthroscopic debridement, marrow-stimulating techniques, autologous chondrocyte transfers and implantation, and allografts), and would depend on the patient's, age, etiology, grade, and quality of the lesion.
What is a grade 4 chondral defect?
Grade IV - The cartilage may wear away completely, leaving the underlying bone exposed in small or widespread areas. When the involved areas are large, pain usually becomes more severe, causing a limitation in activity.
What is chondral loss in the shoulder?
Isolated chondral lesions of the glenohumeral joint, particularly in younger patients, are one of the management challenges of shoulder surgery. These lesions can result in shoulder pain and mechanical symptoms.
How do you fix a chondral defect?
Cartilage transplant or autologous cultured chondrocytes (cartilage cells) on a collagen membrane [MACI] can be used to treat focal cartilage defects. This is a two-stage cell-based procedure, because it requires an initial arthroscopic procedure to harvest the cells (small biopsy from your cartilage).
Does Grade 4 chondromalacia require surgery?
Surgical stabilization of the cartilage defect may be needed. Surgical stimulation to replace lost cartilage is successful in cases where the surrounding cartilage is healthy.
How do you treat full thickness of cartilage loss?
Treatment of Cartilage Defects In the case of global thinning of the cartilage such as seen with osteoarthritis, the treatment is typically conservative including rest, ice, anti-inflammatory medication, cortisone injection, and physical therapy or a home exercise program.
What is Grade 4 chondromalacia in shoulder?
Grade 4 – Grade 4 chondromalacia indicates that there is complete loss of cartilage with exposed subchondral bone. Grade 4 changes can be focal (involve a small area of cartilage), or it can be diffuse where it affects a large surface area.Oct 28, 2020
What happens when you have no cartilage in your shoulder?
As the cartilage disappears, the joint becomes stiff, reducing range of motion, and limiting activity, often causing interference with even the most common tasks of everyday life, such as dressing, reaching for objects, and even personal hygiene.
What does full thickness cartilage loss mean shoulder?
Full thickness chondral defects and osteochondral defects of the shoulder can cause numerous problems for the patient such as pain, swelling, locking, and may lead to early osteoarthritis.
What does chondral loss mean?
A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone.
What causes chondral loss?
Cartilage loss caused by a direct injury can result from blunt trauma to the joint. This can be from a severe car accident or even a very bad fall where the joint makes direct impact with the ground. If you're an athlete, sporting injuries are also a cause of cartilage loss.
Can a chondral defect heal itself?
Because cartilage does not heal itself well, doctors have developed surgical techniques to stimulate the growth of new cartilage. Restoring articular cartilage can relieve pain and allow better function.
What are chondral lesions?
Chondral lesions are encountered in approximately 5% of shoulder arthroscopies, predominantly as incidental findings. 1 These lesions comprise focal defects, such as the small idiopathic chondral defect and postdislocation Hill-Sachs lesion, as well as more diffuse chondral damage as seen in osteoarthritis. Although the precise etiology and natural history of these lesions remains controversial, associations have been demonstrated with entities such as instability and its treatment, rotator cuff pathology, and elite-level overhead-throwing activities. Approximately 8% to 12% of shoulders with recurrent instability will show Grade 3 and 4 chondral lesions 2, 3; early nonanatomic techniques such as the Putti-Platt and Bristow procedures resulted in arthritic changes in as many as 60% of cases. 4 Full-thickness rotator cuff tears are associated with major chondral defects (those greater than 150 mm 2) in 4.5% of cases, 5 and elite-level overhead-throwing athletes demonstrated such lesions in up to 17%. 6 Extensive chondral damage also has been reported in association with malpositioned or loosened metal anchors, 7 radiofrequency application, 8 and, more recently, after intraarticular infusion of bupivacaine for postoperative analgesia. 9
What are the complications of cartilage repair?
Complications associated with open approaches include deltoid avulsion or denervation and subscapularis rupture, while arthroscopic procedures have risks associated with fluid extravasation, such as respiratory compromise. ACI in the knee has an approximately 25% reoperation rate for the debridement of hypertrophic tissue from the periosteal patch coverage; the risk of this complication in the shoulder is currently unknown. Osteochondral autograft procedures are associated with donor site morbidity, while allografts have a theoretical, but very low risk of disease transmission, mostly from viral diseases such as HIV or Hepatitis.
What are glenoid defects?
Chondral defects of the glenoid ( Fig. 17) represent a challenging problem for articular cartilage repair due to thin cartilage and limited subchondral bone stock. Several techniques have been developed to address glenoid lesions by biological resurfacing with a soft tissue interposition graft, such as fascia lata or capsule. In theory, this soft-tissue graft will provide a soft and smooth motion interface that will not undergo rapid degeneration. More recently, other graft choices have been investigated, including xenograft (Restore Patch, Depuy), achilles tendon and lateral meniscal allografts. Long-term outcome studies are not available for any of these techniques, which should be regarded as salvage procedures.
Is ACI good for shoulder?
There are no scientific studies beyond a single case report 20 to provide evidence that ACI will be as successful in the shoulder as it has been in the k nee. However, it does offer a potential treatment option in young patients with symptomatic articular cartilage defects of the shoulder. Furthermore, it does not preclude any other treatments such as osteoarticular allografting, surface replacement, or hemiarthroplasty should symptoms warrant further intervention. We have treated four patients with this technology to date with very encouraging results similar to that which was reported in our initial case report.
Can a physical examination reveal a rotator cuff?
With long-standing symptoms, physical examination can reveal rotator cuff or deltoid atrophy, but usually strength is near normal levels. Range of motion generally is preserved in all but severe arthritic changes. Unfortunately, standard physical tests are not sensitive or specific for the detection of chondral defects. Ellman et al11described a “compression-rotation” test to distinguish impingement-type symptoms from pain associated with cartilage lesions. For this test, the examiner compresses the humeral head against the glenoid while the patient rotates his or her arm, eliciting pain if substantial defects are present. It has been our experience that patients with chondral lesions often have symptoms in the mid-ranges of rotation that are heightened when compression is added across the glenohumeral joint.
How thick is the glenoid fossa?
In comparison to the knee, the articular cartilage of the humeral head and glenoid fossa are thin at 1.24 and 1.88 mm thick respectively, which leaves less margin before exposure of the subchondral bone. It should be noted that this margin is even thinner at the periphery of the humeral head and at the center of the glenoid fossa.
Is chondral deformity more common in shoulder?
However, increased awareness, and the widespread use of magnetic resonance imaging and arthroscopy has allowed for a more conscientious and thorough evaluation of the articular surfaces which in turn has demonstrated that chondral defects in the shoulder are more common than previously thought.
Is glenohumeral joint asymptomatic?
Finally, chondral defects of the glenohumeral joint are generally very well tolerated and often asymptomatic, thus it is incumbent upon the evaluating physician to properly determine and treat other more common sources of shoulder pain prior to embarking on cartilage-specific treatment.
Is glenohumeral cartilage a poorly understood condition?
While much has been written regarding the treatment of chondral lesions in the knee,1 until recently glenohumeral articular cartilage lesions have remained a poorly understood and usually incidentally diagnosed entity. However, increased awareness, and the widespread use of magnetic resonance imaging and arthroscopy has allowed for ...
Can glenohumeral osteoarthritis progress?
While the natural history of these chondral lesions is largely unknown, they may progress to glenohumeral osteoarthritis. While rare glenohumeral osteoarthritis can have significant effects on a patient’s global function, with declines in health-related quality of life on-par with diabetes and coronary artery disease.
What is a grade 4 chondral defect?
A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. In this regard, what is Grade 4 Chondrosis of the knee?
What is chondral damage?
Chondral damage is graded from mild to severe, and all grades can have characteristics of osteoarthritis. Grade I - The cartilage "blisters" and becomes soft in the earliest form of damage. Grade II and III - As the condition worsens, the cartilage may become fibrillated (it has a shredded appearance). Also, what does full thickness chondral loss ...
What is the grade of chondral damage?
Chondral damage is graded from mild to severe , and all grades can have characteristics of osteoarthritis. Grade I - The cartilage "blisters" and becomes soft in the earliest form of damage. Grade II and III - As the condition worsens, the cartilage may become fibrillated (it has a shredded appearance).
What is a chondral injury?
An articular cartilage injury, or chondral injury, may occur as a result of a pivot or twist on a bent knee, similar to the motion that can cause a meniscus tear. Damage may also be the result of a direct blow to the knee. Chondral injuries may accompany an injury to a ligament, such as the anterior cruciate ligament.
What is the condition called when a bone fragment detaches from the articular cartilage?
A loose bone fragment may be detected in a condition called osteochondritis dissecans (OCD), in which a portion of bone detaches with the articular cartilage.
Where do you take cartilage plugs?
This procedure involves the transfer of normal cartilage from one area of the knee to another. Cartilage plugs are taken from areas of the knee that do not bear the weight of the body during walking, and then "planted" in the damaged areas with a technique that is similar to the one used for a hair transplant.
Can a chondral injury cause knee swelling?
Chondral injuries may accompany an injury to a ligament, such as the anterior cruciate ligament. Small pieces of the articular cartilage can actually break off and float around in the knee as loose bodies, causing locking, catching, and/or swelling. More often, there is no clear history of a single injury.
Diagnosis
Your diagnosis is full-thickness (Grade IV) cartilage loss of the inner (medial) weight-bearing compartment.
Injury or Condition
Cartilage cracking, fragmentation and erosion over time has resulted in full-thickness loss of your weight-bearing (articular) cartilage, often altering the alignment of your lower extremity towards bowing (bow-legged). This condition is osteoarthritic in nature.
Cause
The most common cause is abnormal “wear and tear” of the weight-bearing (articular) cartilage layer within the medial (inner) weight-bearing compartment exposing bare bone. This may have evolved from an unrecognized, high-impact injury, excessive weight or prolonged weight-bearing on hard surfaces.
Symptoms
The typical symptom is increased pain related to weight-bearing activities which is relieved by rest. The pain is often consistently located along the medial (inner) aspect of the knee. Swelling and weakness are commonly present. A loss of knee motion (straightening or bending), and limping are often present.
Recovery
Total recovery is rare. Treatment is designed to relieve pain, improve knee function and delay the requirement of knee replacement surgery. In cases treated by arthroscopic surgery alone, recovery is gradual, over 2-6 months.
How to treat OCD?
OCD is generally treated by keyhole surgery, with a technique called 'microfracture'. This has been shown to have excellent results in pain relief and functional improvement ( Snow & Funk, IJSS, 2008 ). Loose bodies can also be removed at the same time by arthroscopy.
Can OCD cause shoulder pain?
Over time, it is likely to progress to osteoarthritis of the shoulder joint. OCD lesions may be on the glenoid or humeral head, or both. What are the Symptoms? OCD causes shoulder pain and sometimes stiffness. Often the cartilage that has broken off from the bone surfaces can be floating freely in the joint.