Glenoid Microfracture With or Without Arthroscopic Rotator Cuff Repair: Similar Rates of Return to Full Duty and Patient-Reported Outcome Measures Among Active-Duty Military Patients

Background: Concomitant arthroscopic rotator cuff repair (ARCR) and microfracture (MFX) for glenoid articular cartilage lesions among active-duty servicemembers yields lower return-to-duty rates than ARCR alone; however, there is no existing comparison with outcomes after MFX alone to elucidate where these discrepancies arise. Purpose: To compare postoperative outcomes and return-to-duty rates after MFX for glenoid cartilage lesions with and without ARCR. Study Design: Cohort study; Level of evidence, 3. Methods: Active-duty servicemembers 18 to 50 years of age who underwent either simultaneous ARCR/MFX or isolated MFX between January 2010 and August 2021 were eligible for inclusion if they had Outerbridge grade 4 glenoid articular cartilage lesions with or without full-thickness rotator cuff tears. All patients had at least 2 years of follow-up. Patient-reported outcome measures (PROMs), range of motion (ROM), return to duty, adverse events, and reoperations were collected and analyzed. Results: Ultimately, 38 patients were eligible for inclusion in the ARCR/MFX cohort and 28 in the MFX cohort, with higher mean age (42.5 vs 35.3 years, P < .0004), higher mean preoperative pain scores (8.2/10 vs 7.1/10, P = .0183), and lower mean preoperative ASES scores (42.9 vs 49.1, P = .0424) among patients with ARCR/MFX. Both cohorts demonstrated significant improvements in pain and PROMs (P < .0001); however, there were no significant differences in final postoperative values between the cohorts. Postoperative ROM was slightly more limited after ARCR/MFX compared with MFX (forward flexion: 154.6 degrees +/- 9.9 degrees vs 158.4 degrees +/- 4.5 degrees, P = .0300; external rotation: 61.2 degrees +/- 8.2 degrees vs 68.0 degrees +/- 4.6 degrees, P = .0007; internal rotation: T10.8 +/- 2.0 vs T9.5 +/- 2.0, P = .0357). There were no significant differences among complications (P = .2076), and rates of return to duty were similar between the cohorts (71.4% for ARCR/MFX, 73.7% for MFX; P = .8389). Conclusion: Patients undergoing MFX of glenoid articular cartilage defects with or without concomitant ARCR were found to have significant improvements in pain and PROMs, with very slight limitations in postoperative ROM observed among patients with concomitant ARCR. The results of this study suggest that active-duty military patients undergoing glenoid MFX with ARCR have similar final pain scores, PROMs, complication rates, and return-to-duty rates to patients undergoing MFX alone and can assist in preoperative counseling regarding military career management and postoperative expectations.