Cartilage Injuries and Arthritis

Diagnosis and therapy of cartilage injuries of the glenohumeral joint constitute a special clinical challenge, particularly in the young and active patient. These lesions are often accompanied by concomitant pathologies, and in contrast to the weight-bearing joints including the knee and the hip, specific treatment regimens are missing. The diagnostic value of physical examination with rather unspecific clinical signs and radiographic imaging is limited. Arthroscopy therefore remains the gold standard in the diagnosis of cartilage lesions. Therapeutic aims are pain relief, functional improvement, and prevention or delay of the development of osteoarthritis. Conservative measures include pharmacotherapy, hyaluronic acid injection, viscosupplementation, and physical therapy. When nonsurgical therapy is unsuccessful, shoulder arthroplasty constitutes a feasible treatment option for older patients. In young and active patients, the techniques of autologous chondrocyte implantation (ACI), osteochondral auto- or allograft transplantation (OAT), microfracture, and minced cartilage implantation have been investigated and developed to repair or regenerate glenohumeral cartilage defects. Biologic interposition arthroplasty and partial resurfacing constitute further options to delay or avoid total shoulder arthroplasty. However, to date experience for the treatment of glenohumeral cartilage defects is limited and therapy algorithms are still missing.