Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, University of Colorado, Aurora, Colorado, USA.
Am J Sports Med. 2018 Mar;46(4):786-794. doi: 10.1177/0363546517750627. Epub 2018 Jan 26.
Microfracture is an effective surgical treatment for full-thickness cartilage defects of the knee; however, little is known regarding long-term outcomes after microfracture in the shoulder.
To present long-term clinical outcomes of patients undergoing microfracture of full-thickness articular cartilage defects of the glenohumeral joint.
Case series; Level of evidence, 4.
Sixteen consecutive patients (17 shoulders) were retrospectively reviewed who underwent arthroscopic microfracture of the humeral head and/or glenoid surface, with or without additional procedures between 2001 and 2008 and with a minimum follow-up of 8.5 years. All patients completed pre- and postoperative surveys containing the visual analog scale, American Shoulder and Elbow Surgeons form, and Simple Shoulder Test. Complications and reoperations were analyzed. Failure was defined by biological resurfacing or conversion to arthroplasty.
Of the original 16 patients (17 shoulders), 13 patients (14 shoulders) were available for mean follow-up at 10.2 ± 1.8 years after microfracture (range, 8.5-15.8 years), for an overall clinical follow-up rate of 82%. The patients (6 men, 7 women) were 36.1 ± 12.9 years old at time of microfracture. The average size of humeral head defects was 5.20 cm (range, 4.0-7.84 cm), and the average size of glenoid defects was 1.53 cm (range, 1.0-3.75 cm). Four patients (4 shoulders) underwent at least 1 reoperation, and 3 were considered to have structural failures. The average time to failure was 3.7 years after microfracture (range, 0.2-9.6 years). The overall survival rate was 76.6% at 9.6 years. For these patients, there were statistically significant improvements in visual analog scale, Simple Shoulder Test, and American Shoulder and Elbow Surgeons scores as compared with preoperative values at long-term follow-up ( P < .05 for all), without any significant change from short-term (mean, 2.3 years) to long-term (mean, 10.2 years) follow-up. There was no significant difference in Single Assessment Numeric Evaluation or Short Form-12 Physical or Mental scores between short- and long-term follow-up. When compared with short-term follow-up, in which 2 patients had already failed, 1 additional patient progressed to failure at 9.6 years after the original microfracture. Two patients (2 shoulders) were considered to have clinical failure. Owing to the overall number of failures (3 structural failure and 2 clinical failure), the total long-term success rate of glenohumeral microfracture is 66.7% in the current study.
Treating full-thickness symptomatic chondral defects of the glenohumeral joint with microfracture can result in long-term improved function and reduced pain for some patients. However, in this case series, 21.4% of patients required conversion to arthroplasty <10 years after the index microfracture procedure, and 33% to 42% of patients were considered to have potential clinical failure. Additional studies with larger patient cohorts are needed.
微骨折术是治疗膝关节全层软骨缺损的有效手术方法；然而，对于肩关节全层关节软骨缺损的微骨折术的长期结果知之甚少。
介绍行肩关节全层关节软骨缺损关节镜下微骨折术患者的长期临床结果。
病例系列；证据水平，4 级。
回顾性分析 2001 年至 2008 年间行肱骨头和/或肩胛盂表面关节镜下微骨折术的 16 例连续患者（17 个肩关节），且术中均进行或未进行附加手术，随访时间至少 8.5 年。所有患者均完成术前和术后调查，包括视觉模拟量表、美国肩肘外科医生评分和简易肩部测试。分析并发症和再次手术。将生物修复或转换为关节置换术定义为失败。
16 例患者（17 个肩关节）中，13 例（14 个肩关节）在微骨折术后 10.2 ± 1.8 年（8.5-15.8 年）时接受平均随访，整体临床随访率为 82%。患者（6 男，7 女）在微骨折时年龄为 36.1 ± 12.9 岁。肱骨头缺损的平均大小为 5.20 cm（范围，4.0-7.84 cm），肩胛盂缺损的平均大小为 1.53 cm（范围，1.0-3.75 cm）。4 例（4 个肩关节）患者至少进行了 1 次再次手术，其中 3 例被认为存在结构失败。微骨折术后平均失败时间为 3.7 年（范围，0.2-9.6 年）。9.6 年时的总体生存率为 76.6%。与术前相比，这些患者在长期随访时视觉模拟量表、简易肩部测试和美国肩肘外科医生评分均有显著改善（所有 P <.05），从短期（平均 2.3 年）到长期（平均 10.2 年）随访时没有显著变化。短期和长期随访之间的单一评估数值评估或短型 12 项健康调查量表物理或精神评分均无显著差异。与短期随访（其中 2 例已失败）相比，在最初的微骨折后 9.6 年，又有 1 例患者进展为失败。2 例（2 个肩关节）被认为存在临床失败。由于总的失败例数（3 例结构失败和 2 例临床失败），当前研究中全层肩盂微骨折的长期总成功率为 66.7%。
用微骨折术治疗全层有症状的肩盂关节软骨缺损可使部分患者长期改善功能和减轻疼痛。然而，在本病例系列中，21.4%的患者在指数微骨折术后 10 年内需要转换为关节置换术，33%-42%的患者可能存在临床失败。需要更大患者队列的进一步研究。
