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Online ISSN 1827-1707
Savoie F. H.
Orthopedic Surgery Tulane University School of Medicine, New Orleans, LA, USA
This paper is a review of the currently successful methods of arthroscopically resurfacing of the glenoid without humeral replacement. Degenerative arthritis may occur in young patients due to a variety of factors, including trauma, surgery, and genetic predisposition. In these young patients total shoulder arthroplasty is often contraindicated due to patient dissatisfaction and early failure due to a refusal to modify activity. In a select group of patients with a preserved, round humeral head glenoid resurfacing is a reasonable alternative gain time and allow activity. We have previously reported on a group of 20 patients, age 15-58, mean 32, with severe glenohumeral arthritis were prospectively managed by arthroscopic resurfacing of the glenoid with a biologic patch (Restore, DePuy; Warsaw, IN, USA). Data collected preoperatively and postoperatively included active and passive range of motion, ASES, Constant-Murley, Rowe, UCLA, SF-12 and VAS pain scores. All patients had pre- and postoperative imaging, either computed tomography scan (2) or magnetic resonance imaging (18). Fifteen patients (75%) remained satisfied at last follow-up. Five patients (25%) later had humeral surface replacement due to progression of the disease within six years of the index surgery, but four of these five said they would do the arthroscopic procedure again. Active and passive range of motion improved in flexion (80 to 150), abduction (60 to 120), external rotation at side (10 to 30), external rotation in abduction (30 to 70) and internal rotation (10 to 50). Each rating scale utilized showed statistically significant (P<0.05) improvement: VAS (8 preop → 2 postop), ASES (22.3 → 77.5 out of 100), UCLA (14.5 → 28.5 out of 35), Rowe (55 → 81.25 out of 100) and Constant-Murley (26.25 → 78.65). Six of eight parameters on the SF – 12 also showed statistically significant improvements. Arthroscopic glenoid resurfacing of the shoulder provided results similar to humeral hemiarthroplasty and is a viable alternative to shoulder humeral replacement in the young active patient at midterm follow-up in this initial pilot study.