Non-prosthetic management of grade IV osteochondral lesions of the glenohumeral joint

Osteochondral lesions of the glenohumeral joint in early stages and in younger patients are an important problem and present a challenge during clinical decision making. Although prosthetic arthroplasty remains the gold standard for treatment in later stages of the disease, alternatives are desirable in the early stages and in young patients. The purposes of this study are to evaluate the results of arthroscopic debridement and capsular release in patients with grade IV osteochondral lesions of the glenohumeral joint and to determine the factors associated with their success. Sixty-one patients with grade IV osteochondral lesions of the glenohumeral articular surfaces were treated with arthroscopic debridement, with or without arthroscopic capsular release. Standardized data collection was performed at the initial office visit and at the time of final follow-up. Overall outcome was analyzed with regard to patients' self-assessment of pain, function, improvement, satisfaction, and duration of pain relief. Forty-five of the patients had a minimum follow-up of 2 years. Time-to-event analysis was used to evaluate the duration of pain relief. The mean patient satisfaction score (0 = not satisfied; 7 0 completely satisfied) improved from 0.67 preoperatively to 6.28 at final follow-up (P < .0001), with 87% of patients indicating that they would have the surgery again. Although workers' compensation patients obtained inferior results, significant improvement in pain and function was obtained in 88% of all patients (P < .0001). Most patients noted the onset of pain relief within 5 weeks of surgery and obtained a duration of pain relief of 28 months or greater (P < .05). The addition of concomitant procedures, such as acromioplasty, distal clavicle resection, labral debridement, or labral repair, did not have a negative impact on the functional results after arthroscopic debridement and capsular release. In well-selected patients with grade IV osteochondral lesions of the glenohumeral joint, significant improvements in pain relief and function follow arthroscopic debridement of the glenohumeral joint. Arthroscopic capsular release can be added in patients with a loss of passive arcs of shoulder motion. Osteochondral lesions greater than 2 cm(2) appear to be associated with return of pain and failure of this procedure.