Outcomes After Microfracture for Concomitant Glenoid and Humeral Head Osteochondral Defects in Active-Duty Military...

Microfracture offers a joint-preserving treatment for glenohumeral osteochondral defects, although its application to bipolar defects remains understudied, especially among an active-duty servicemember (ADSM) population.

To evaluate outcomes after microfracture of bipolar glenoid and humeral head lesions in ADSM aged <55 years.

Case series; Level of evidence, 4.

ADSM aged <55 years were eligible for inclusion if they underwent microfracture for Outerbridge grade IV bipolar glenohumeral cartilage lesions identified on diagnostic arthroscopy at various locations within the joint and had >5 years of postoperative follow-up. All patients underwent concomitant arthroscopic subacromial debridement and other procedures that did not necessitate extended postoperative immobilization, while those with concomitant rotator cuff or labral repair were excluded. Outcomes included patient-reported outcome measures-specifically, pain on visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons standardized assessment-and range of motion, return to duty, and arthroplasty-free survivorship.

In total, 31 patients were eligible for inclusion (mean ± SD age, 45.7 ± 8.1 years; male, 90.3%; mean follow-up, 8.0 ± 1.9 years). On average, glenoid and humeral head lesions measured 247 ± 155 and 201 ± 137 mm², respectively. All patient-reported outcome measures demonstrated significant improvements postoperatively independent of lesional size (visual analog scale, 8.2 ± 1.8 to 1.7 ± 1.8; Single Assessment Numeric Evaluation, 51.0 ± 18.8 to 80.5 ± 14.9; American Shoulder and Elbow Surgeons, 47.0 ± 11.7 to 85.2 ± 12.5; P < .0001 for all). Internal rotation improved slightly (T10.5 ± 2.4 to T9.1 ± 2.5; P = .0109); otherwise, range of motion remained stable. At final follow-up, 71% (n = 22) returned to full duty and 65% (n = 20) to preinjury level of sport. Two patients (6.5%) experienced symptom progression and underwent total shoulder arthroplasty at 6 and 8 years postoperatively at ages 52 and 62 years, respectively.

Microfracture of bipolar glenohumeral osteochondral lesions among ADSM yields significant improvements in pain and shoulder function; however, rates of return to unrestricted duty and former level of sport were limited, and 6.5% of patients ultimately underwent total shoulder arthroplasty 6 to 8 years postoperatively. While microfracture begets symptomatic relief for many young, active patients with bipolar osteochondral lesions and appears to offer several years of improved symptom management, return to full occupational and athletic function remains limited and warrants appropriate patient education and counseling.