Patients › Shoulder
Komprehensibong Arthroskopikong Pamamahala (CAM)
The Comprehensive Arthroscopic Management (CAM) procedure — a joint-preserving arthroscopic alternative to arthroplasty for glenohumeral osteoarthritis, combining debridement, capsular release, osteophyte excision, microfracture, loose-body removal and axillary nerve neurolysis.
Bakit ito ang inirekomendang operasyon¶
Ang Comprehensive Arthroscopic Management ay isang sistematikong paraan upang gamutin ang maagang pagkasira ng arthritis sa iyong balikat. Inirekomenda ito ng iyong doktor dahil mayroon kang higit sa 2 mm na espasyo sa kasu-kasuan at magkasya pa rin ang mga ibabaw ng iyong kasu-kasuan nang walang malaking deformity. Ang prosedurang ito ay isang opsyon na naglalayong panatilihin ang kasu-kasuan, na idinisenyo para sa mga mas batang, aktibong pasyente na may advanced na arthritis at gustong iwasan ang pagpapalit ng kasu-kasuan.
Karaniwang sinisimulan ang mga hindi operasyonal na paggamot. Ang operasyon ay isasagawa lamang kapag hindi sapat ang pag-unlad mula sa mga paraang ito. Layunin ng operasyong ito na bawasan ang sakit at mapabuti ang pag-andar sa pamamagitan ng paglilinis ng nasirang tissue at pag-resurface ng kasu-kasuan. Ito ay isang maaasahang alternatibo sa malaking operasyon para sa mga aktibong indibidwal. Ang layunin nito ay bigyan ka ng maayos na benepisyo sa maikling panahon habang pinapanatili ang iyong natural na istruktura ng kasu-kasuan hangga't maaari.
Bago ang operasyon¶
Mangyaring mag-fasting ng walong oras bago ang iyong operasyon. Ipapaliwanag ng iyong surgeon kung aling mga gamot ang dapat itigil. Mag-ayos ng taong magdadala sa iyo pauwi. Dalhin ang listahan ng lahat ng kasalukuyang gamot. Maaaring kailanganin ng X-rays, MRI scans, o blood tests. Ang mga pagsusuring ito ay tumutulong sa iyong surgeon na magplano nang ligtas. Ang pagsusuri ng anaesthetist ay nagpapatunay na angkop ka para sa operasyon. Magsuot ng komportableng damit sa iyong appointment. Ang paghahanda na ito ay tumutulong upang magsimula nang maayos ang iyong paggaling. Gusto ng iyong team na handa ka para sa Comprehensive Arthroscopic Management. Ang pamamaraang ito ay nagpapagamot ng maagang wear-and-tear arthritis sa iyong balikat. Ang pagiging handa ay nagbabawas ng stress at pinapanatili ang iyong kaligtasan.
Sa araw ng operasyon¶
Dadating ka sa ospital sa umaga para sa iyong pagpasok. Kumpirmahin ng iyong doktor ang iyong mga detalye at sagutin ang anumang huling tanong na mayroon ka. Pagkatapos, makikilala mo ang anestesiyologo, na magpapakita ng plano para sa iyong kaginhawaan. Ang operasyong ito ay isinasagawa sa ilalim ng pangkalahatang anestesya na pinagsama ng regional nerve block. Ikaw ay ganap na matutulog sa panahon ng operasyon, at ang block (isang injeksyon na nagpapabango sa mga nerbiyong nagbibigay ng damdamin sa braso bago ka gumising) ay nagbibigay ng pagpapagaan ng sakit sa unang 12 hanggang 24 oras pagkatapos ng operasyon. Makikilala ka ng anestesiyologo bago ang operasyon at ipapaliwanag niya ang parehong bahagi.
Dadalhin ka sa operating theatre habang ikaw ay gumagising pa. Ihahanda ng koponan ang iyong sarili para sa proseso. Hindi mo mararamdaman o alaala ang anumang bagay sa panahon ng operasyon. Pagkatapos ng operasyon, gagising ka sa recovery area. Susubaybayan ng mga nars ang iyong antas ng sakit at siguraduhing matatag ka. Mananatili ka doon hanggang sa mawala ang anestesya at handa ka nang umuwi o pumunta sa ward.
Ano ang kinabibilangan ng operasyon¶
Ang Comprehensive Arthroscopic Management (CAM) ay isang sistematikong pamamaraan na ginagamit upang gamutin ang maagang pagkasira o arthritis sa iyong balikat. Ang iyong doktor-surgeon ay gagawa ng prosedurong ito gamit ang arthroscopy, na nangangahulugang paggamit ng maliliit na keyhole incisions imbes na isang malaking bukas na putol. Pinapayagan nito ang iyong doktor-surgeon na makita nang malinaw ang loob ng joint habang pinapanatili ang minimal na pinsala sa iyong balat at kalamnan.
Sa loob ng operasyon, alinlangan ng iyong doktor-surgeon na linisin ang joint. Ang prosesong ito, na kilala bilang debridement, ay kinabibilangan ng pag-alis ng nasirang tissue at dumi na maaaring magdulot ng sakit at stiffness. Kung kinakailangan, maaari ring gawin ng iyong doktor-surgeon ang glenoid resurfacing. Ibig sabihin nito ang pagpapakinis o pagpapakabago ng hugis ng socket na bahagi ng iyong balikat upang mapabuti ang paggalaw nito kasama ang ball ng itaas na buto ng braso. Maaari ring paluwagin ng iyong doktor-surgeon ang mahigpit na mga tissue sa paligid ng joint upang matulungan ang pagbabalik ng iyong range of motion.
Ang layunin ay mapanatili ang natural na istruktura ng iyong joint. Ang pamamaraang ito ay partikular na inirerekomenda para sa mga pasyenteng may higit sa 2 mm ng natitirang espasyo ng joint at ang mga buto ng kanilang balikat ay nananatiling aligned nang walang malaking deformity. Ito ay naglilingkod bilang isang joint-preserving alternative sa joint replacement, na karaniwang inilaan para sa mga kaso na may mas malubhang pinsala sa buto o incongruity.
Pagkatapos makumpleto ang prosedura, isasara ng iyong doktor-surgeon ang maliliit na incisions. Ang eksaktong paraan ng pagsara ay nakadepende sa iyong partikular na kaso, ngunit karaniwang kinabibilangan ng sutures o glue upang matulungan ang balat na gumaling nang tama. Susunod na ilalagay ang isang dressing upang protektahan ang lugar. Ang prosedurang ito ay dinisenyo upang bawasan ang sakit at mapabuti ang function, na nag-aalok ng isang predictable na short-term na opsyon para sa mga mas batang, aktibong pasyenteng may advanced shoulder arthritis.
Pagkatapos ng operasyon¶
Gising ka sa recovery ward. Ang iyong surgeon ang mag-aalaga ng iyong sakit at susuriin ang iyong sugat. Magdudulot ka ng sling at may dressing sa iyong balikat. Maaari mong galawin ang iyong mga daliri at siko nang dahan-dahan. Karamihan sa mga pasyente ay nananatili ng isang gabi sa ospital pagkatapos ng operasyong ito, bagaman may mga makakapagpunta sa bahay sa parehong araw. May kailangang makatira sa iyo sa unang 24 na oras upang tulungan ka. Huwag magmaneho ng hindi bababa sa anim na linggo pagkatapos ng anumang operasyon sa balikat. Ang patakaran na ito ay nagsasapat anuman ang braso na na-operahan. Kailangan mong alisin ang sling bago magmaneho. Iiwan ka ng iyong surgeon pagkatapos ng iyong six-week review. Para sa karagdagang detalye, tingnan ang Pagmamaneho pagkatapos ng upper-limb surgery.
Pagbawi¶
Maaaring maranasan mo ang ilang sakit at pamamaga sa unang ilang araw pagkatapos ng iyong operasyon. Karaniwan ito. Maaaring maramdaman mong matigas o masakit ang iyong balikat habang ito ay nagsisimulang gumaling. Bibigyan ka ng gamot ng iyong doktor upang mapamahalaan ang hindi komportableng pakiramdam. Ang paglalagay ng ice pack ay maaari ring bawasan ang pamamaga at ginhawa ang sakit. Ipahinga ang iyong braso nang hangga’t maaari sa maagang yugto na ito.
Magdudulot ka ng sling upang protektahan ang iyong balikat habang ito ay gumagaling. Ituturo ng iyong pisyoterapeuta ang mga banayad na ehersisyo upang panatilihin ang paggalaw ng iyong kasukasuan. Maliit at kontrolado ang mga galaw na ito. Huwag magbitbit ng mabibigat na bagay o umabot pataas. Ang mga simpleng gawain tulad ng pagkain o paghuhugas ng ngipin ay maaaring kailanganin ng pagsasanay. Karaniwan, makakatulog ka sa iyong likod na may unan na sumusuporta sa iyong braso. Ang posisyong ito ay tumutulong upang panatilihin ang katatagan at kaginhawaan ng balikat.
Habang humihina ang pamamaga, unti-unting dadagdagan mo ang iyong aktibidad. Gabay ng iyong pisyoterapeuta ang iyong pagpapatupad ng mas hamon na mga ehersisyo habang bumabalik ang iyong lakas. Malalaman mo na handa ka para sa susunod na hakbang kapag pinapayagan ka ng iyong doktor. Halimbawa, maaari kang bumalik sa pagmamaneho lamang kapag pinapayagan ng iyong doktor. Karaniwan itong nangyayari sa iyong pagsusuri sa anim na linggo. Huwag mamaneho habang naka-sling. Maaaring magkaiba ang iyong timeline; gabay ng iyong doktor at pisyoterapeuta ang iyong pag-unlad batay sa iyong partikular na progreso.
Maaaring mangyari¶
Karamihan sa mga pasyente ay magagaling, ngunit minsan ay maaaring magkaroon ng mga problema. Ang iyong surgeon at ang koponan ay mahigpit na nagmamasid sa iyo upang maagang matukoy ang anumang isyu.
Kung mayroon kang wear-and-tear arthritis sa shoulder joint, karaniwang nakakatulong ang arthroscopic treatment sa paggalaw at kaginhawaan. Bihirang mangyari ang mga seryosong isyu. Gayunpaman, hindi laging inirerekomenda ang paraang ito para sa karaniwang paggamit dahil kulang ang matibay na ebidensya tungkol sa kanyang long-term na benepisyo. Balansihin ng iyong surgeon ang mga salik na ito nang mabuti bago ituloy ang proseso.
Para sa shoulder instability, magkakaiba ang mga resulta depende sa partikular na teknik na ginamit. Mayroong sariling profile ang bawat paraan. Mahalagang talakayin kung alin sa mga opsyon ang angkop sa iyong balikat. Aalamin ng iyong surgeon ang mga detalye upang matukoy kung ang arthroscopy ang tamang pagpipilian para istabilisa ang iyong joint.
Kung mayroon kang malaking tear sa mga rotator cuff tendons, maaaring isaalang-alang ang debridement (paglilinis ng nasirang tissue). Hindi pa ganap na nauunawaan ang long-term na epekto ng pamamaraang ito. Kailangan ng karagdagang pagsusuri upang malaman kung paano ito aapektuhan ka sa mga susunod na taon. Tandaan ang hindi pagkaka-alam na ito habang nagpaplano para sa iyong paggamot.
Sa napakabihirang mga kaso, maaaring magdulot ang isang seryosong impeksyon sa shoulder joint ng post-infectious arthritis. Ibig sabihin, may permanenteng pinsala sa joint na mangyayari pagkatapos ng impeksyon, kahit na ikaw ay magkaroon ng paulit-ulit na operasyon upang gamutin ito. Ito ay hindi maiiwasang konsekwensya ng ganitong uri ng seryosong impeksyon. Kung ikaw ay nag-aalala ng isang seryosong impeksyon, humingi ng agad na tulong medikal.
Ang table ng mga komplikasyon sa pahinang ito ay naglalaman ng mga karaniwang rate kung gusto mo ng mga detalye.
Kailan tawagan ang aming klinika¶
Tawagan kami kung may lagnat, lumalalang pamumula o paglabas ng likido sa sugat, o biglaang matinding sakit. Pumunta sa emergency room kung napansin mong may pamamaga sa binti o hirap sa paghinga. Tawagan agad kung mawalan ng pakiramdam o hindi na makagalaw ang iyong kamay o paa. Huwag magmaneho ng hindi bababa sa anim na linggo pagkatapos ng operasyon. Ang iyong doktor ang magbibigay ng pahintulot na magmaneho sa iyong pagsusuri sa ika-anim na linggo.
Evidence & references
Overview¶
- The Comprehensive Arthroscopic Management (CAM) procedure is a systematic, inclusive approach to the array of pathologies encountered in early glenohumeral arthritis [1].
- The CAM procedure provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis by reducing pain and improving function [2].
- The CAM procedure reduced pain, improved function, and provided reasonable short-term durability for young, active patients with advanced shoulder OA, serving as a joint-preserving alternative to arthroplasty [3].
- Arthroscopic debridement improved clinical outcome in 68% of patients suffering from advanced OA of the glenohumeral joint [5].
- The CAM procedure demonstrated significant improvements in midterm clinical outcomes and high patient satisfaction after the procedure for glenohumeral osteoarthritis, with a 76.9% survivorship rate at a minimum of 5 years postoperatively [6].
- Treatment of glenohumeral arthritis with arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures in patients with failed previous arthroscopic debridement [7].
- CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings [10].
- Hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) are feasible options for patients with humeral head incongruity or large anterior osteophytes [10].
- Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands, though long-term consequences require further evaluation [11].
- Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [12].
- Surgical arthroscopic repair was possible in all cases of acute or recurrent instability in soccer goalkeepers with well-defined exclusion criteria [14].
Anatomy & Pathophysiology¶
- The CAM procedure is a systematic, inclusive approach to the array of pathologies encountered in early glenohumeral arthritis [1].
- Advanced glenohumeral osteoarthritis is characterized by joint space loss and abnormal posterior glenoid shape [9].
- Humeral head flattening and severe joint incongruity are identified as risk factors for failure in patients undergoing arthroscopic treatment for glenohumeral osteoarthritis [22].
Classification¶
- Comprehensive Arthroscopic Management (CAM) is defined as a systematic, inclusive approach to the array of pathologies encountered in early glenohumeral arthritis [1].
- CAM provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [2].
- CAM serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [3].
- Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [5].
- CAM achieves significant improvements in midterm clinical outcomes and high patient satisfaction after the procedure for glenohumeral osteoarthritis [6].
- The survivorship rate of the arthroscopic CAM procedure is 76.9% at a minimum of 5 years postoperatively [6].
- Arthroscopic glenoid resurfacing provides superior results for the treatment of glenohumeral arthritis compared to previously performed arthroscopic procedures [7].
- An arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [8].
- The CAM procedure reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis [9].
- Patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [9].
- CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings [10].
- Hemiarthroplasty or total shoulder arthroplasty are feasible options for patients with humeral head incongruity or large anterior osteophytes [10].
- Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [12].
- Arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [13].
- Surgical arthroscopic repair is possible for acute or recurrent instability with well-defined exclusion criteria [14].
- Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [15].
Clinical Presentation¶
- Comprehensive Arthroscopic Management (CAM) is recommended for the array of pathologies encountered in early glenohumeral arthritis [1].
- CAM provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [2].
- CAM serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [3].
- Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [5].
- The CAM procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction for glenohumeral osteoarthritis [6].
- The CAM procedure has a 76.9% survivorship rate at a minimum of 5 years postoperatively [6].
- Arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures for treating glenohumeral arthritis [7].
- An arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [8].
- Patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [9].
- CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings [10].
- Total shoulder arthroplasty (TSA) or hemiarthroplasty (HA) are feasible options for patients with humeral head incongruity or large anterior osteophytes [10].
- Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands [11].
- Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [12].
- Arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [13].
- Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [15].
- Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in range of motion and patient-reported outcomes with minimal complications [17].
- Arthroscopic debridement with capsular release may provide a window of improved symptoms and function before joint deterioration leads to more significant operations, especially in younger patients with mild or moderate osteoarthritic changes [19].
- Arthroscopic debridement and biological resurfacing of the glenoid is a minimally invasive therapeutic option for pain relief, functional improvement, and patient satisfaction in glenohumeral osteoarthritis in the intermediate-term [20].
Investigations¶
- The Comprehensive Arthroscopic Management (CAM) procedure is recommended as a systematic, inclusive approach to pathologies encountered in early glenohumeral arthritis [1].
- CAM provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis by reducing pain and improving function [2].
- The CAM procedure reduces pain, improves function, and provides reasonable short-term durability for young, active patients with advanced shoulder osteoarthritis, serving as a joint-preserving alternative to arthroplasty [3].
- Arthroscopic stabilization results are variable, requiring individual analysis of each technique to determine the role of arthroscopy in glenohumeral stabilization [4].
- Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [5].
- The CAM procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction, with a 76.9% survivorship rate at a minimum of 5 years postoperatively [6].
- Arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures for the treatment of glenohumeral arthritis [7].
- An arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [8].
- Patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [9].
- CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings, while hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) are feasible options for those with humeral head incongruity or large anterior osteophytes [10].
- Arthroscopic debridement is an excellent treatment for elderly patients with massive rotator cuff tears and modest functional demands, though long-term consequences require further evaluation [11].
- Surgical arthroscopic repair is possible for acute or recurrent instability in soccer goalkeepers with well-defined exclusion criteria [14].
- Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [15].
- Arthroscopic debridement with capsular release may provide a window of improved symptoms and function before joint deterioration leads to more significant operations, especially in younger patients with mild or moderate osteoarthritic changes [19].
- Arthroscopic debridement, facetectomy, and synovectomy aim to decrease pain originating from the patellofemoral joint by eliminating pain sources from the subchondral bone and synovium [21].
- The survivorship rate of the CAM procedure at minimum 10-year follow-up is 63.2%, with humeral head flattening and severe joint incongruity identified as risk factors for failure [22].
- Progressive radiographic osteoarthritic changes following arthroscopic debridement of massive irreparable rotator cuff tears do not negatively influence clinical results [27].
Treatment¶
- Comprehensive Arthroscopic Management (CAM) is recommended as a systematic, inclusive approach for the array of pathologies encountered in early glenohumeral arthritis [1].
- CAM provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis by reducing pain and improving function [2].
- CAM reduces pain, improves function, and provides reasonable short-term durability for young, active patients with advanced shoulder osteoarthritis, serving as a joint-preserving alternative to arthroplasty [3].
- Arthroscopic stabilization results are variable, and each technique must be analyzed individually to determine the role of arthroscopy in glenohumeral stabilization [4].
- Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [5].
- The arthroscopic CAM procedure for glenohumeral osteoarthritis demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction, with a 76.9% survivorship rate at a minimum of 5 years postoperatively [6].
- Arthroscopic glenoid resurfacing provided superior results for the treatment of glenohumeral arthritis compared to previously performed arthroscopic procedures in patients with failed prior debridement [7].
- An arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [8].
- The CAM procedure reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis, but patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure [9].
- CAM is a reasonable option for patients with primary glenohumeral arthritis younger than 50 years old who have localized cartilage defects and specific radiographic findings [10].
- Total shoulder arthroplasty or hemiarthroplasty are feasible options for patients with primary glenohumeral arthritis younger than 50 years old who have humeral head incongruity or large anterior osteophytes [10].
- Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [12].
- Arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [13].
- Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [15].
- Arthroscopic debridement, facetectomy, and synovectomy aim to decrease pain originating from the patellofemoral joint by eliminating pain sources from the subchondral bone and synovium [21].
- Most perioperative costs associated with the arthroscopic treatment of glenohumeral instability are facility utilization and implant costs [26].
Complications¶
- Arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [13].
- Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications [17].
- The majority of patients demonstrated sustained improvement in patient-reported outcomes and satisfaction without conversion to total shoulder arthroplasty at long-term follow-up, although some patients progressed to arthroplasty [16].
- After the CAM procedure, 76.9% survivorship was observed at a minimum of 5 years postoperatively [6].
- After the CAM procedure, 84% survivorship was found at 3 years and 72% survivorship at 5 years [30].
Recovery¶
- The CAM procedure provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis by reducing pain and improving function [2].
- The CAM procedure reduced pain, improved function, and provided reasonable short-term durability for young, active patients with advanced shoulder OA [3].
- The CAM procedure serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder OA [3].
- The CAM procedure reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis (GHOA) [9].
- Patients with less joint space are significantly more likely to progress to early failure after the CAM procedure [9].
- Patients with abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [9].
- The CAM procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction for GHOA [6].
- The CAM procedure has a 76.9% survivorship rate at a minimum of 5 years postoperatively [6].
- The majority of patients demonstrated sustained improvement in patient-reported outcomes and satisfaction without conversion to total shoulder arthroplasty at long-term follow-up after the CAM procedure [16].
- Some patients progressed to arthroplasty after the CAM procedure at long-term follow-up [16].
- Arthroscopic debridement improved clinical outcome in 68% of patients suffering from advanced OA of the glenohumeral joint [5].
- An arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [8].
- Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands [11].
- Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [12].
- Arthroscopic debridement of the shoulder improves regaining external rotation in patients with osteoarthritis of the glenohumeral joint [18].
- Arthroscopic debridement of the shoulder decreases pain in patients with osteoarthritis of the glenohumeral joint [18].
- Arthroscopic debridement of the shoulder improves the ability to perform activities of daily living (ADLs) in patients with osteoarthritis of the glenohumeral joint [18].
- Arthroscopic debridement and biological resurfacing of the glenoid provides pain relief, functional improvement, and patient satisfaction in glenohumeral osteoarthritis in the intermediate-term [20].
Key Evidence¶
- [L4] The authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis: the Comprehensive Arthroscopic Management (CAM) procedure. [1] (10.1016/j.arthro.2022.01.033)
- [Paper] The comprehensive arthroscopic management procedure provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis by reducing pain and improving function. [2] (10.1016/j.eats.2015.04.003)
- [L4] The CAM procedure reduced pain, improved function, and provided reasonable short-term durability for young, active patients with advanced shoulder OA, serving as a joint-preserving alternative to arthroplasty. [3] (10.1016/j.arthro.2012.10.028)
- [L4] The results of arthroscopic stabilization reported in the literature are variable and each technique must be analyzed individually to properly determine the role of arthroscopy in glenohuminal stabilization. [4] (10.1177/03635465000280042801)
- [L3] Arthroscopic debridement improved clinical outcome in 68% of patients suffering from advanced OA of glenohumeral joint. [5] (10.1186/s12891-015-0741-9)
- [L4] This study demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction after the arthroscopic CAM procedure for GHOA, with a 76.9% survivorship rate at a minimum of 5 years postoperatively. [6] (10.1177/0363546516656372)
- [L4] Treatment of glenohumeral arthritis with arthroscopic glenoid resurfacing provided superior results in this series to their previously performed arthroscopic procedure. [7] (10.1016/j.arthro.2009.04.015)
- [L5] Clinical studies report that an arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period. [8] (10.5435/jaaos-d-17-00214)
- [L3] The CAM procedure reliably improves pain and function in active patients with advanced GHOA, but patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure. [9] (10.1177/0363546516668823)
- [L4] CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings, while HA or TSA are feasible options for those with humeral head incongruity or large anterior osteophytes. [10] (10.1530/eor-2023-0156)
- [L3] Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands, though long-term consequences require further evaluation. [11] (10.1007/s00402-004-0738-6)
- [L4] Although there are limited nonarthroplasty surgical options available for glenohumeral arthritis, isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients. [12] (10.1016/j.arthro.2014.08.025)
- [L1] This systematic review shows that arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use. [13] (10.1016/j.arthro.2013.02.022)
- [L4] Surgical arthroscopic repair was possible in all cases of acute or recurrent instability with well-defined exclusion criteria. [14] (10.1055/s-0032-1327656)
- [L4] Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis. [15] (10.1007/s00167-023-07377-0)
- [L4] The majority of patients demonstrated sustained improvement in patient-reported outcomes and satisfaction without conversion to total shoulder arthroplasty at long-term follow-up, although some patients progressed to arthroplasty. [16] (10.1177/2325967121s00213)
- [L1] Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. [17] (10.1016/j.arthro.2020.02.036)
- [L4] Arthroscopic debridement of the shoulder has a role to play in the management of osteoarthritis of the glenohumeral joint, with the most improvement in regaining external rotation, decreasing pain, and improvement in the ability to perform ADLs. [18] (10.1016/j.arthro.2010.04.032)
- [L4] Arthroscopic debridement with capsular release may provide a window of improved symptoms and function before deterioration of the joint leads to a more significant operation, especially in younger patients with mild or moderate osteoarthritic changes. [19] (10.1016/j.arthro.2006.11.016)
- [L4] Arthroscopic debridement and biological resurfacing of the glenoid is a minimally invasive therapeutic option for pain relief, functional improvement and patient satisfaction, in glenohumeral osteoarthritis, in the intermediate-term. [20] (10.1007/s00167-010-1155-8)
- [L4] The technique aims to decrease pain originating from the patellofemoral joint and related structures by eliminating pain sources from the subchondral bone and synovium. [21] (10.1016/j.eats.2021.08.021)
- [L3] The survivorship rate at minimum 10-year follow-up was 63.2%, with humeral head flattening and severe joint incongruity identified as risk factors for failure. [22] (10.1177/0363546520962756)
- [L4] Most perioperative costs associated with the arthroscopic treatment of glenohumeral instability are facility utilization and implant costs. [26] (10.1016/j.jseint.2020.01.006)
- [L4] Although progressive radiographic osteoarthritic changes occur, they do not negatively influence clinical results. [27] (10.1016/j.arthro.2008.03.007)
- [L4] After the CAM procedure we found an 84% survivorship at 3 years and 72% survivorship at 5 years. [30] (10.1177/2325967116s00104)
References¶
[1] Comprehensive Arthroscopic Management of Shoulder Arthritis. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.01.033 [2] The Comprehensive Arthroscopic Management Procedure for Treatment of Glenohumeral Osteoarthritis. Arthroscopy Techniques. 2015. DOI: 10.1016/j.eats.2015.04.003 [3] Comprehensive Arthroscopic Management (CAM) Procedure: Clinical Results of a Joint‐Preserving Arthroscopic Treatment for Young, Active Patients With Advanced Shoulder Osteoarthritis. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2012.10.028 [4] Arthroscopic Management of Glenohumeral Instability. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280042801 [5] Relationship between probability of future shoulder arthroplasty and outcomes of arthroscopic debridement in patients with advanced osteoarthritis of glenohumeral joint. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0741-9 [6] Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516656372 [7] Arthroscopic Glenoid Resurfacing: Results in Patients With Failed Previous Arthroscopic Debridement (SS‐14). Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.015 [8] Arthroscopic Management of Glenohumeral Arthritis: A Joint Preservation Approach. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00214 [9] Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516668823 [10] Comprehensive arthroscopic management versus total shoulder arthroplasty and hemiarthroplasty in patients with primary glenohumeral arthritis younger than 50 years old. EFORT Open Reviews. 2026. DOI: 10.1530/eor-2023-0156 [11] Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Archives of Orthopaedic and Trauma Surgery. 2004. DOI: 10.1007/s00402-004-0738-6 [12] Arthroscopic Debridement and Capsular Release for the Treatment of Shoulder Osteoarthritis. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.08.025 [13] What Is the Role of Arthroscopic Debridement for Glenohumeral Arthritis? A Critical Examination of the Literature. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.02.022 [14] Arthroscopic Treatment of Glenohumeral Instability in Soccer Goalkeepers. International Journal of Sports Medicine. 2012. DOI: 10.1055/s-0032-1327656 [15] Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07377-0 [16] Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00213 [17] Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.02.036 [18] Arthroscopic Debridement and Capsular release of the Shoulder as a Treatment for Osteoarthritis of the Glenohumeral Joint (SS‐22). Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.04.032 [19] Arthroscopic Debridement and Capsular Release for Glenohumeral Osteoarthritis. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.016 [20] Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1155-8 [21] Arthroscopic Debridement, Facetectomy, and Synovectomy for Isolated Patellofemoral Osteoarthritis. Arthroscopy Techniques. 2021. DOI: 10.1016/j.eats.2021.08.021 [22] Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520962756 [26] A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability. JSES International. 2020. DOI: 10.1016/j.jseint.2020.01.006 [27] Arthroscopic Debridement of Massive Irreparable Rotator Cuff Tears. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.03.007 [30] Survivorship after Arthroscopic Management of Glenohumeral Osteoarthritis with a Minimum 5 year Follow-up. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00104