Pieringer Alexander, Do Anh, Freislederer Florian, Scheibel Markus
Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Arthrosc Tech. 2024 Jun 3;13(9):103049. doi: 10.1016/j.eats.2024.103049. eCollection 2024 Sep.
Anterior shoulder dislocations often are associated with cartilage defects of the anterior glenoid (glenolabral articular disruption, or GLAD lesions). However, the importance of GLAD lesions for shoulder stability is usually greatly underestimated. Moreover, glenoid cartilage defects may have a high clinical relevance as the result of persistent pain and possible progression to osteoarthritis. Therefore, surgical treatment appears to be necessary. Although in older patients prosthetic arthroplasty is a useful treatment option for progressive symptomatic cartilage defects, there is still disagreement about the ideal joint-preserving method for the treatment of isolated glenoid cartilage defects, especially in younger and more active patients. In recent years, autologous chondrocyte implantation has been established as a promising treatment option for focal cartilage defects. However, most autologous chondrocyte implantation techniques have the disadvantage of requiring 2 surgical procedures and the availability of specialized laboratories, making the techniques complex and expensive. In contrast, the AutoCart procedure (Arthrex, Munich, Germany) is a cost-effective one-step procedure in which the cartilage defect is filled with a mixture of minced autologous cartilage and autologous conditioned plasma and has already shown good clinical results in the knee joint. We present an arthroscopic technique for use in glenoid cartilage defects.
肩关节前脱位常与前盂肱关节软骨损伤(盂唇关节面损伤,即GLAD损伤)相关。然而,GLAD损伤对肩关节稳定性的重要性通常被大大低估。此外,由于持续性疼痛以及可能进展为骨关节炎,盂肱关节软骨损伤可能具有较高的临床相关性。因此,手术治疗似乎是必要的。尽管对于症状性进展性软骨损伤,人工关节置换术对老年患者是一种有效的治疗选择,但对于孤立性盂肱关节软骨损伤的理想保关节治疗方法仍存在争议,尤其是对于年轻且活动较多的患者。近年来,自体软骨细胞移植已成为治疗局限性软骨损伤的一种有前景的治疗选择。然而,大多数自体软骨细胞移植技术的缺点是需要进行两次手术,且需要专门的实验室,这使得该技术复杂且昂贵。相比之下,AutoCart手术(德国慕尼黑的Arthrex公司)是一种经济有效的单步手术,其中软骨缺损用切碎的自体软骨和自体条件血浆的混合物填充,并且已在膝关节显示出良好的临床效果。我们介绍一种用于盂肱关节软骨缺损的关节镜技术。