Focal Articular Cartilage Lesions of Superior Humeral Head

Articular cartilage is the highly specialized connective tissue of diarthrodial joints. Its main function is to provide a smooth, lubricated surface for articulation and to facilitate the transmission of loads with a low frictional coefficient. The articular cartilage does not have blood vessels, lymphatics, and nerves. Articular cartilage is quite susceptible to injury and has a limited capacity for intrinsic healing and repair. Protecting the health of the articular cartilage is quite important for joint health. Its unique and complex structure makes treatment and repair or restoration of the defects challenging for the patient, the surgeon, and the physical therapist.

Focal articular cartilage lesions of the superior humeral head are defects that appear along the superior surface of the posterior humeral head, medial to the expected location of a Hill-Sachs lesion. Focal articular cartilage defects are not usually seen in the glenohumeral joint. These lesions are mostly found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. This type of lesion does not always have any specific mechanism of injury.

The diagnosis of the same are quite tricky and most often not easily caught on MRI but arthroscopy seems to be more successful in finding this. This can also be found during the open surgical procedure for treating some other shoulder condition. Those suffering from focal articular cartilage lesions always seem to complain of an acute onset of shoulder pain especially after any single traumatic event.

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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Q&As on focal articular cartilage lesions superior humeral head

How do focal articular cartilage lesions of the superior humeral head lead to Hill-Sachs lesions?

Focal articular cartilage lesions of the superior humeral head are defects that develop medial to the predicted site of a Hill-Sachs lesion along the superior surface of the posterior humeral head. The glenohumeral joint seldom exhibits focal articular cartilage abnormalities. An injury that develops as a result of an anterior shoulder dislocation is called a Hill-Sachs lesion. The anterior portion of the glenoid and the humeral head “collide,” resulting in bone loss, lesion, defect, and deformity of the humeral head. It can cause a shift in the range of motion loss, sensations of instability, and discomfort.

How is the injury differentiated on focal articular cartilage lesions of the superior humeral head?

A grading system is used, and it is determined how severe the humeral head deformity is and the amount of bone loss. Patients who suffer from anterior shoulder instability are at an increased risk of developing a Hill-Sachs lesion, which can reach a prevalence of one hundred percent. A Bankart lesion is a different kind of disease that may occur due to an anterior shoulder dislocation. This is an injury to the anterior glenoid labrum of the shoulder and is often accompanied by a Hill-Sachs lesion.

Which is the best surgical method for focal articular cartilage lesions of the superior humeral head?

The glenohumeral articulation connects the head of the humerus to the glenoid cavity of the scapula. It is the primary joint in the shoulder girdle and is responsible for movement between the two bones. For the treatment of glenohumeral osteochondral lesions in young, highly active individuals, various joint-preserving surgical procedures are available. However, it is still being determined which strategy yields the best results. The surgical procedures, including non-arthroplasty, showed respectable rates of radiographic healing, better patient-reported outcomes, few complications, and low failure or reoperation rates. However, the pace of arthritis development was quick. Joint preservation methods are probably effective ways to maintain the original shoulder’s functionality and provide short- to medium-term pain alleviation.

What is postoperative rehabilitation for focal articular cartilage lesions of the superior humeral head?

For the first two weeks post surgery, the only component of the rehabilitation regimen was wearing a sling. The day after surgery, immediate passive mobilisation got underway under the guidance of a physiotherapist. Three weeks following surgery, active assisted exercises in the pool and within the range of motion without discomfort were initiated. After eight weeks, operational activities were started using a rubber band to balance the shoulder’s internal and external rotators. Additionally, all patients had physical therapy for around six months in our facility’s outpatient rehabilitation programme to strengthen the shoulder and increase the range of motion until maximum recovery was shown.

Why are advanced MRI techniques most accurate in diagnosing focal articular cartilage lesions of the superior to the humeral head?

Lesions of the superior articular cartilage of the humeral head are uncommon lesions that might induce clinical symptoms but are easy to miss on traditional MR imaging and X-rays. These lesions are caused by trauma, but they do not seem to have a particular damage mechanism. They manifest in a specific position (focal articular cartilage lesions superior or posterior humeral head, medial to the site of a Hill-Sachs lesion) and are found in a particular location. As MR imaging of cartilage has improved, this region of the shoulder should be evaluated for the presence of this lesion. This is because of the advancements.