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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