Autologous cartilage implantation (ACI) for lesions on the glenoid and humerus

Focal cartilage defects in the glenohumeral joint remain challenging in both diagnostic and therapeutic management, especially in the young and active patients. The incidence of cartilage defects has been reported to be as high as 13-57% in patients with rotator cuff tears, in overhead throwing athletes, and in the unstable shoulders. Patients with cartilage defects in either the glenoid or humerus present with a vast variety of symptoms including constant deep shoulder pain or sharp pain, crepitation, or generalized achiness during activity. If symptomatic and when conservative treatment fails, current literature reports on a variety of surgical options including joint-preserving interventions and prosthetic joint replacement. Small cartilage defects (<2 cm2) are best treated with one-step bone marrow stimulation techniques or debridement. If isolated symptomatic large cartilage defects (>2 cm2) are present, autologous chondrocyte implantation as a two-step procedure may be considered. However, current data is limited to a few small investigations. Of importance, concomitant injuries such as rotator cuff tears, long head of the bicep's lesions, or disruptions of the labrum should be treated to avoid further cartilage damage and progression of osteoarthritis.