What Is Arthroscopic Cartilage Repair?
Arthroscopic cartilage repair restores damaged articular cartilage in the shoulder using one of several techniques selected based on defect size, location, and depth. The procedure addresses focal cartilage injuries that produce pain, catching, and progressive joint damage if left untreated. Dr. Chudik selects from microfracture, osteochondral autograft transfer, and osteochondral allograft transplantation depending on the specific defect.
Articular cartilage covers the ends of the humeral head and glenoid, allowing the joint to glide almost frictionlessly. When cartilage is damaged by trauma, instability, or chronic loading, the underlying bone is exposed to higher contact stresses. Without repair, defects tend to enlarge over time and progress toward arthritis.
Arthroscopic cartilage repair uses several techniques, selected by defect size and depth:
- Microfracture: small awl perforations in the subchondral bone stimulate marrow elements to produce fibrocartilage that fills the defect. Used for small defects (less than 2 cm²).
- Osteochondral Autograft Transfer (OATS): cylindrical plugs of cartilage and underlying bone are taken from a less-loaded area (typically the knee) and transferred into the defect. Used for small to medium defects.
- Osteochondral Allograft Transplantation: cadaveric cartilage and bone graft is transplanted into the defect. Used for larger defects.
Who Is a Candidate?
Candidates for arthroscopic cartilage repair typically have:
- Symptomatic focal cartilage defects on MRI
- Pain, catching, or progressive symptoms not controlled by non-surgical treatment
- Adequate surrounding cartilage and joint alignment
- A medical profile that allows safe surgery
- Willingness to undergo the protected post-operative protocol
Patients with diffuse arthritis or established advanced cartilage loss are typically better served by other procedures (joint preservation surgery, arthroplasty in older patients).
How the Procedure Is Performed
The procedure is performed arthroscopically through standard portals. The cartilage defect is identified, debrided of unstable cartilage flaps, and measured to confirm the surgical plan.
For microfracture, an awl is used to make small holes through the subchondral bone plate. Marrow elements migrate through these holes and form a fibrin clot that gradually transforms into fibrocartilage.
For OATS, a cylindrical plug of healthy cartilage and underlying bone is harvested from a non-weight-bearing area (typically the knee). The recipient site in the shoulder is prepared with a matching cylindrical hole. The autograft plug is press-fit into the recipient site.
For osteochondral allograft, a sized plug of donor cartilage and bone is implanted into a precision-prepared recipient site in the shoulder.
Recovery and Rehabilitation
Recovery depends on the procedure:
- After microfracture: protected loading of the arm for four to six weeks, progressive motion, and return to activity at four to six months
- After OATS or allograft: similar protected loading initially, longer healing timeline, and return to activity at six to nine months
- Return to overhead sport varies from four to nine months depending on technique and defect location
Risks and Outcomes
Risks include graft failure, persistent pain, infection, and progression to arthritis despite repair. Outcomes for focal cartilage procedures are best when the defect is identified and treated early, before it enlarges or damages the opposing surface.
Outcomes vary by technique. Microfracture produces fibrocartilage, which is mechanically inferior to native hyaline cartilage but adequate for many defects. OATS and allograft transplantation restore hyaline-like cartilage but require larger surgical exposure and longer recovery.
Why Dr. Chudik for Arthroscopic Cartilage Repair
Dr. Chudik treats the full spectrum of shoulder cartilage pathology and selects from microfracture, OATS, and allograft transplantation based on defect characteristics. His arthroscopic experience allows precise defect assessment and treatment through small portals. For larger defects in younger patients, his selection of cartilage restoration techniques is informed by knee experience where these procedures originated.