This type of shoulder injury is suspected to be caused when extreme force is applied to the cartilage. As a matter of fact, osteochondral lesions of the humeral head near the rotator cuff insertion have been seen in the setting of posterior internal impingement mostly in sportspeople that throw overhand but articular cartilage lesions of the humeral head is comparatively a rarer occurrence.
Focal articular cartilage defects are often asymptomatic and well tolerated. Some patients, found that these lesions cause unremitting, activity-related shoulder pain for years after minor shoulder trauma. Substantially reduced active range of motion could also be another symptom. Such articular cartilage lesions can also cause mechanical symptoms within the joint like grinding or catching sensation during specific shoulder motions.
Initial management of this defect is nonsurgical and includes physical therapy or corticosteroid injections. In the event that non-surgical options fail to provide relief then the next option are surgical methods. Some preferred surgical treatment options include arthroscopic debridement, microfracture surgery, osteochondral autograft or allograft transplantation, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation.
Osteochondral autograft transplantation involves harvesting one to three osteochondral autograft plugs, typically from a non–weight-bearing portion of the joint, and using a press-fit technique to transfer these plugs into the chondral defect site. Debridement and microfracture is performed arthroscopically whereas osteochondral autograft transplantation will require an open approach to gain full access to the joint. Implantation of particulated juvenile cartilage allograft has shown good results in other joints and is yet to be applied to shoulder defects.
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