Cartilage is the protective surface that covers the ends of the bones and helps the shoulder joint move smoothly and without pain. Cartilage may become damaged with age, wear and tear, or injury.
Arthroscopic procedures can clean up torn or worn cartilage edges and treat certain limited areas of cartilage damage to improve symptoms and function.
What Is Arthroscopic Cartilage Repair?
Dr. Chudik performs cartilage repair and transplant procedures arthroscopically through small incisions.
Arthroscopic shavers and ablation instruments are used to remove and contour torn, loose cartilage. Several cartilage restoration techniques may be used depending on the location and severity of the cartilage damage:
- Abrasionplasty: The cartilage defect is cleaned back to stable borders, and the base is abraded to a bleeding surface so blood and bone marrow elements can fill the defect.
- Microfracture: Deeper holes are created to access blood and bone marrow components.
- Autologous Chondrocyte Implantation: This two-stage procedure first involves harvesting cartilage cells and growing them in a laboratory. During a second surgery, periosteal tissue or a synthetic collagen matrix is placed in the cartilage defect and the cells are introduced into the area in an attempt to regrow and fill the defect.
- Osteochondral Autologous Transfer (OATs): A piece of healthy bone and cartilage is taken from a lesser weight-bearing area of another joint and transferred into the damaged area.
- Osteochondral Allograft Transplant: For larger defects, a bone and cartilage plug from a cadaver is transplanted into the cartilage-deficient area.
Who Is a Candidate?
Cartilage repair, transfer, or transplantation may be considered for patients with certain limited areas of cartilage damage.
Contraindications include:
- Infection
- Inability or unwillingness to complete an appropriate postoperative rehabilitation program
- Diffuse, advanced arthritis of the shoulder without mechanical symptoms
The specific treatment depends on the location and severity of the cartilage damage.
How the Procedure Is Performed
Dr. Chudik performs cartilage repair and transplant procedures arthroscopically through small incisions.
Arthroscopic shavers and ablation instruments are used to remove and contour torn or loose cartilage. Depending on the cartilage damage, treatment may include abrasionplasty, microfracture, autologous chondrocyte implantation, osteochondral autologous transfer, or osteochondral allograft transplantation.
Some cartilage procedures may require an open approach rather than being performed entirely arthroscopically.
Recovery and Rehabilitation
Following surgery:
- A sling is worn at all times except for bathing, dressing, and exercises for six weeks, including while sleeping
- The repaired shoulder should not be actively moved using its own muscles for up to six weeks to protect the repair and allow healing
- Patients may be more comfortable sleeping upright after surgery
- Arthroscopic wounds should be kept clean and dry for three days; wounds from an open procedure should remain clean and dry for 10 to 14 days
- Wounds should not be submerged in water for three weeks
- Driving may resume after approximately six to eight weeks
- Return to school or sedentary work may occur within one to two weeks as long as the sling is worn and the affected arm is not used
- Physical therapy should begin two to three days after surgery and continue for approximately four to six months
Return to activity may occur when there is no pain and full shoulder range of motion, strength, endurance, and functional use have been restored. This usually requires approximately four to six months.
Depending on the severity of the cartilage damage and type of repair, Dr. Chudik may recommend additional activity restrictions.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Shoulder stiffness or loss of motion
- Failure of cartilage grafts or treatments to heal sufficiently
- Continued pain and progressive arthritis
- Persistent swelling and symptoms
- Possible need for total shoulder replacement
Cartilage restoration procedures may improve symptoms and function in patients with certain patterns of cartilage damage, but they do not restore the joint surface to its original normal condition.
Why Dr. Chudik for Arthroscopic Cartilage Repair
Dr. Chudik performs cartilage repair, transfer, and transplant procedures arthroscopically when appropriate and selects among several cartilage restoration options based on the specific location and severity of the cartilage damage.
Treatment options may include abrasionplasty, microfracture, autologous chondrocyte implantation, osteochondral autologous transfer, and osteochondral allograft transplantation.