Comprehensive arthroscopic management of the shoulder

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

History

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

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 .

Contraindications

Contraindications of the procedure include :

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 :

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 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 < 2mm as well as low preoperative ASES-scores .

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