Patients › Shoulder
Gestão Artroscópica Abrangente (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.
Por que esta operação foi sugerida¶
O Manejo Artroscópico Abrangente é uma abordagem sistemática para o tratamento da artrite por desgaste precoce na sua articulação do ombro. Seu cirurgião provavelmente recomendou este procedimento porque você possui mais de 2 mm de espaço articular e as superfícies articulares ainda se encaixam bem, sem deformidade significativa. Este procedimento é uma opção de preservação articular, indicada para pacientes mais jovens e ativos com artrite avançada que desejam evitar a substituição articular.
Os tratamentos não operatórios geralmente vêm primeiro. A cirurgia é considerada apenas quando esses métodos não proporcionam melhora suficiente. Esta operação visa reduzir a dor e melhorar a função por meio da remoção do tecido danificado e do ressurfacing da articulação. Serve como uma alternativa confiável à cirurgia de grande porte para indivíduos ativos. O objetivo é proporcionar um benefício de curto prazo previsível, preservando a estrutura natural da sua articulação pelo maior tempo possível.
Antes da cirurgia¶
Jejum por oito horas antes da sua cirurgia. O seu cirurgião indicará quais medicamentos deve suspender. Organize o transporte para ser levado de volta para casa. Traga uma lista de todos os medicamentos que está a tomar atualmente. Poderá ser necessário realizar radiografias, ressonâncias magnéticas ou análises ao sangue. Estas avaliações ajudam o seu cirurgião a planear de forma segura. Uma avaliação anestésica assegura que está apto para a cirurgia. Vista roupas confortáveis para a sua consulta. Esta preparação ajuda a que a sua recuperação comece de forma tranquila. A sua equipa deseja que esteja preparado para a Gestão Artroscópica Completa. Esta abordagem trata a artrose inicial por desgaste na sua ombreira. Estar preparado reduz o stress e mantém a sua segurança.
No dia da cirurgia¶
Você chegará ao hospital pela manhã para sua internação. Seu cirurgião confirmará seus dados e responderá a quaisquer perguntas finais. Em seguida, você conhecerá o anestesiologista, que explicará o plano para o seu conforto. Esta operação será realizada sob anestesia geral combinada com um bloqueio nervoso regional. Você ficará completamente adormecido durante a cirurgia, e o bloqueio (uma injeção que adormece os nervos que suprem o braço antes de você despertar) proporcionará alívio da dor nas primeiras 12 a 24 horas após a cirurgia. O anestesiologista o encontrará antes da operação e explicará ambas as etapas.
Você será levado ao centro cirúrgico enquanto ainda estiver acordado. A equipe o preparará para o procedimento. Você não sentirá nem lembrará de nada durante a cirurgia em si. Após a operação, você despertará na área de recuperação. Os enfermeiros monitorarão seus níveis de dor e garantirão que você esteja estável. Você permanecerá lá até que o efeito anestésico passe e você esteja pronto para ir para casa ou para um quarto.
O que a cirurgia envolve¶
A Gestão Artroscópica Abrangente (CAM) é uma abordagem sistemática utilizada para tratar a artrite por desgaste precoce na sua articulação do ombro. O seu cirurgião realiza este procedimento utilizando artroscopia, o que significa fazer pequenas incisões em forma de fechadura de porta, em vez de uma grande incisão aberta. Isto permite que o seu cirurgião veja claramente o interior da articulação, mantendo ao mínimo o dano à sua pele e aos músculos.
Durante a cirurgia, o seu cirurgião limpará cuidadosamente a articulação. Este processo, conhecido como desbridamento, envolve a remoção de tecido danificado e detritos que podem causar dor e rigidez. Se necessário, o seu cirurgião também pode realizar o recapeamento da glenoide. Isto significa alisar ou remodelar a parte da cavidade da articulação do ombro para melhorar a sua movimentação em relação à cabeça do úmero. O seu cirurgião pode também libertar os tecidos tensos em torno da articulação para ajudar a restaurar a sua amplitude de movimento.
O objetivo é preservar a estrutura natural da sua articulação. Esta abordagem é especificamente recomendada para pacientes que têm mais de 2 mm de espaço articular restante e cujos ossos do ombro ainda estão alinhados, sem deformidade significativa. Serve como uma alternativa preservadora da articulação à substituição articular, que é tipicamente reservada para casos com dano ósseo mais grave ou incongruência.
Após a conclusão do procedimento, o seu cirurgião fechará as pequenas incisões. O método exato de sutura depende do seu caso específico, mas geralmente envolve pontos ou cola para ajudar a pele a cicatrizar corretamente. De seguida, será aplicada uma cura para proteger a área. Este procedimento foi concebido para reduzir a dor e melhorar a função, oferecendo uma opção previsível a curto prazo para pacientes mais jovens e ativos com artrite avançada do ombro.
Após a cirurgia¶
Você acordará na sala de recuperação. Seu cirurgião controlará sua dor e examinará sua ferida. Você usará uma tipóia e terá um curativo no ombro. Você pode mover os dedos e o cotovelo suavemente. A maioria dos pacientes permanece uma noite no hospital após esta cirurgia, embora alguns possam ir para casa no mesmo dia. Alguém deve permanecer com você nas primeiras 24 horas para ajudá-lo. Não dirija por pelo menos seis semanas após qualquer cirurgia de ombro. Esta regra se aplica independentemente de qual braço foi operado. Você deve estar sem a tipóia antes de dirigir. Seu cirurgião o liberará na revisão de seis semanas. Para mais detalhes, consulte Dirigir após cirurgia do membro superior.
Recuperação¶
É provável que sinta alguma dor e inchaço nos primeiros dias após a cirurgia. Isto é normal. O ombro pode sentir-se rígido ou dolorido à medida que começa a cicatrizar. O seu cirurgião irá prescrever medicação para ajudar a gerir este desconforto. Aplicar compressas de gelo também pode reduzir o inchaço e aliviar a dor. Descanse o braço tanto quanto possível durante esta fase inicial.
Usará uma atadura para proteger o ombro enquanto ele cicatriza. O seu fisioterapeuta irá ensinar-lhe exercícios suaves para manter a articulação em movimento. Estes movimentos são pequenos e controlados. Não levante objetos pesados nem estique o braço acima da cabeça. Tarefas simples como comer ou escovar os dentes podem exigir prática. Geralmente, pode dormir de costas com uma almofada a apoiar o braço. Esta posição ajuda a manter o ombro estável e confortável.
À medida que o inchaço diminui, irá aumentar gradualmente a sua atividade. O seu fisioterapeuta irá guiá-lo através de exercícios mais desafiadores à medida que a sua força retorna. Saberá que está pronto para o próximo passo quando o seu cirurgião o autorizar. Por exemplo, só poderá voltar a conduzir quando o seu cirurgião der a aprovação. Isto acontece tipicamente na sua avaliação de seis semanas. Não conduza enquanto usar a atadura. O seu cronograma pode diferir; o seu cirurgião e fisioterapeuta irão orientá-lo com base no seu progresso específico.
O que pode dar errado¶
A maioria dos pacientes tem uma boa evolução, mas problemas podem ocorrer ocasionalmente. O seu cirurgião e a equipa monitorizam-no de perto para detetar qualquer problema precocemente.
Se tiver artrite por desgaste na articulação do ombro, o tratamento artroscópico costuma ajudar na mobilidade e no conforto. Complicações graves são raras. No entanto, esta abordagem nem sempre é recomendada para uso rotineiro, uma vez que falta evidência sólida quanto aos seus benefícios a longo prazo. O seu cirurgião irá ponderar cuidadosamente estes fatores antes de prosseguir.
Para a instabilidade do ombro, os resultados variam consoante a técnica específica utilizada. Cada método tem o seu próprio perfil. É importante discutir qual a opção que melhor se adapta ao seu ombro. O seu cirurgião irá analisar os detalhes para determinar se a artroscopia é a escolha adequada para estabilizar a sua articulação.
Se tiver uma rotura grande nos tendões do manguito rotador, pode ser considerada a desbridamento (limpeza do tecido danificado). Os efeitos a longo prazo deste procedimento ainda não são totalmente compreendidos. É necessária mais avaliação para saber como isso o afeta nos anos seguintes. Mantenha esta incerteza em mente ao planear o seu tratamento.
Em casos muito raros, uma infeção grave na articulação do ombro pode levar a uma artrite pós-infecciosa. Isto significa que ocorre dano articular permanente após a infeção, mesmo que sejam realizadas cirurgias repetidas para a tratar. Esta é uma consequência inevitável de uma infeção tão grave. Se suspeitar de uma infeção grave, procure atendimento médico imediato.
A tabela de complicações nesta página lista as taxas típicas, caso queira os detalhes específicos.
Quando nos ligar¶
Ligue-nos se tiver febre, vermelhidão ou secreção crescente na ferida, ou dor intensa súbita. Vá à emergência se notar inchaço na panturrilha ou falta de ar. Ligue imediatamente se perder a sensibilidade ou não conseguir mover o membro. Não dirija por pelo menos seis semanas após a cirurgia. O seu cirurgião autorizará a condução na sua consulta de seis semanas.
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