Comprehensive arthroscopic management of the shoulder

The comprehensive arthroscopic management (CAM) procedure of the shoulder is an arthroscopic joint-preserving technique in the surgical management of glenohumeral osteoarthritis.

History

The comprehensive arthroscopic management was first described by Millet et al. 2010 ¹.

Indications

The comprehensive arthroscopic management procedure was originally introduced as a joint preserving surgical procedure for the management of osteoarthritis in young and active patients ^1-3.

Contraindications

Contraindications of the procedure include ³:

• asymptomatic/early-stage osteoarthritis

• inflammatory arthritis

• osteonecrosis of the humeral head

• complete irreparable rotator cuff tears

• severe joint incongruency

Procedure

The comprehensive arthroscopic management (cam) comprises the following steps ^1-3:

• debridement

• glenohumeral chondroplasty

• extensive capsular release

optional if needed:

• synovectomy

• removal of intraarticular loose bodies

• microfracture

• humeral osteoplasty and resection of osteophytes

• subacromial decompression

• axillary nerve neurolysis

• biceps tenotomy and biceps tenodesis

Complications

Complications of comprehensive arthroscopic management comprise treatment failure and general complications associated with shoulder arthroscopy including:

• acromial, clavicular or proximal humeral fractures

• neurapraxia or nerve injury

• chondrolysis

• septic arthritis

Preoperative imaging

Preoperative radiological imaging includes initial anteroposterior and lateral views of the shoulder for the assessment of glenohumeral osteoarthritis including joint space narrowing and osteophyte formation.

Evaluation of glenoid morphology can be accomplished by CT or MRI.

Assessment of the rotor cuff and long biceps tendon can be done with ultrasound and/or MRI.

Radiological report

The radiological report should include a description of the following:

• joint space narrowing and joint space width

• subchondral sclerosis

• presence and the location of osteophyte formation

• presence of subchondral cysts and/or bone erosion

• glenoid morphology including Walch classification

• evaluation of the rotator cuff and the biceps tendon

• acromial morphology

• other findings e.g. subchondral fractures, signs of osteonecrosis

Outcomes

About 77% of patients show a good outcome meaning did not require shoulder arthroplasty after 5 years. Negative predictors were biconcave glenoid morphology with posterior erosion (Walch B2) and/or glenoid dysplasia with retroversion (Walch C), joint space narrowing <2 mm as well as low preoperative ASES-scores ^3,4.

Comprehensive arthroscopic management in severe shoulder osteoarthritis (Kellgren and Lawrence grade 4) is apparently associated with lower patient satisfaction than in moderate shoulder osteoarthritis (Kellgren and Lawrence grade 3) ^2,3.

See also

• glenohumeral osteoarthritis