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Arthroscopic Microfracture for Focal Glenoid Osteochondral Lesions in Young Active-Duty Military Patients: A Minimum
Erel Ben-Ari1,2, Clare K Green3, John P Scanaliato4
1Division of Orthopaedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
Background:
Glenoid osteochondral defects (OCDs), while uncommon, are a recognized source of shoulder pain and dysfunction, particularly in young, active individuals. Arthroscopic microfracture (MFx) is a commonly used surgical option. However, long-term outcomes remain poorly defined.
Purpose:
To evaluate long-term clinical and functional outcomes after arthroscopic MFx for focal glenoid OCD in active-duty military patients.
Study Design:
Case series; Level of evidence, 4.
Methods:
A retrospective review was conducted of 31 active-duty military patients (<54 years) who underwent arthroscopic MFx for focal, full-thickness (Outerbridge grade 4) glenoid OCD with concomitant biceps tendinitis, subacromial bursitis, and partial rotator cuff (RC) tears, performed by a single surgeon between January 2010 and June 2015. Descriptive data, trauma history, time from symptom onset to surgical intervention, and magnetic resonance imaging (MRI) findings were recorded. Pre- and postoperative clinical assessments included shoulder range of motion (ROM), visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores. Since minimal clinically important differences for glenoid MFx are not defined, validated thresholds from shoulder arthroplasty literature were used for context. Rates of return to sports, military duty, and revision procedures were assessed at final follow-up.
Results:
The mean follow-up was 138 ±14.85 months (range, 120-182 months). The mean age was 36 years (range, 22-54 months), and 94% (29/31) were men. A history of traumatic injury was recorded in 61% (19/31) of patients. The mean time from symptom onset to surgery was 31 ± 46.6 months. No significant differences in ROM were found postoperatively (P > .05). However, all patient-reported outcomes demonstrated statistically significant improvements: VAS (6.84 ± 1.92 to 2.52 ± 2.41), SANE (46.8 ± 20.1 to 81.1 ± 18), and ASES (51.1 ± 14.1 to 82.7 ±17) (P < .0001 for all). At final follow-up, 68% (21/31) returned to sports and 78% (24/31) resumed unrestricted active military duty. Revision procedures were required in 4 patients (13%): 2 underwent total shoulder arthroplasty, and 2 underwent revision MFx with debridement. MRI detected OCD lesions in only 29% (9/31) of cases.
Conclusion:
Arthroscopic MFx offers durable pain relief and functional improvement for focal glenoid OCD with concomitant biceps tendinitis, subacromial bursitis, or partial RC tears in high-demand military patients. At a minimum 10-year follow-up, outcomes demonstrated sustained clinical benefits, high return to duty, moderate return to sports (RTS), and low revision rates. Limited MRI sensitivity and prolonged time to surgical treatment highlight the importance of early clinical suspicion and timely surgical intervention in this challenging population.
