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Comprehensive Arthroscopic Management (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.

Overview

Comprehensive Arthroscopic Management (CAM) is a systematic, inclusive approach recommended for the array of pathologies encountered in early glenohumeral arthritis [1]. The procedure is indicated for patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2]. It serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder OA [4]. While arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands [10], isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [16].

CAM offers excellent survival with avoidance of arthroplasty sustained at a minimum 10-year follow-up in the specified patient population [2]. The procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction for glenohumeral osteoarthritis [7], with a 76.9% survivorship rate at a minimum of 5 years postoperatively [7]. Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced OA of the glenohumeral joint [6]. CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings [9], whereas hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) are feasible options for patients with humeral head incongruity or large anterior osteophytes [9].

Arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures for the treatment of glenohumeral arthritis [8]. The CAM procedure provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [3]. It reduces pain and improves function in this demographic [3], having reduced pain, improved function, and provided reasonable short-term durability for young, active patients with advanced shoulder OA [4].

Anatomy & Pathophysiology

The Comprehensive Arthroscopic Management (CAM) procedure represents a systematic, inclusive approach to the array of pathologies encountered in early glenohumeral arthritis [1]. It serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [4]. CAM is specifically recommended for patients presenting with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2]. While arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands and massive rotator cuff tears [10], it lacks high-quality evidence to support its routine use in the broader glenohumeral arthritis population [18].

Osseous Resurfacing: Arthroscopic glenoid resurfacing provides superior results for glenohumeral arthritis compared to previously performed arthroscopic procedures in patients with failed debridement [8]. Glenoidplasty associated with posterior labral reattachment significantly diminishes shoulder pain in athletes involved in throwing sports [28]. However, humeral head flattening and severe joint incongruity are identified as risk factors for failure of CAM [21].

Clinical Outcomes: 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 [11]. Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in range of motion and patient-reported outcomes with minimal complications [17]. The majority of patients undergoing CAM demonstrate sustained improvement in patient-reported outcomes and satisfaction without conversion to total shoulder arthroplasty at long-term follow-up [15]. Arthroscopic debridement of the shoulder has a role in managing osteoarthritis of the glenohumeral joint, with the most improvement observed in regaining external rotation, decreasing pain, and improving the ability to perform activities of daily living [25]. The survivorship rate of CAM at minimum 10-year follow-up is 63.2% [21].

Classification

CAM Indications: The Comprehensive Arthroscopic Management (CAM) procedure is recommended as a systematic, inclusive approach for the array of pathologies encountered in early glenohumeral arthritis [1]. It is indicated for patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2]. The procedure serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder OA [4] and provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [3]. CAM is also a reasonable option for patients with localized cartilage defects and specific radiographic findings [9].

Outcomes and Survivorship: The CAM procedure offers excellent survival with avoidance of arthroplasty sustained at a minimum 10-year follow-up in patients meeting specific radiographic criteria [2]. It demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction after the procedure for glenohumeral osteoarthritis [7]. The procedure has a 76.9% survivorship rate at a minimum of 5 years postoperatively for glenohumeral osteoarthritis [7]. CAM reduces pain and improves function in younger, high-demand patients with advanced glenohumeral osteoarthritis [3], reduces pain, improves function, and provides reasonable short-term durability for young, active patients with advanced shoulder OA [4], and reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis [12]. Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced OA of the glenohumeral joint [6]. 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 [11]. Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [13].

Failure Criteria and Alternatives: Patients with less joint space are significantly more likely to progress to early failure after the CAM procedure [12]. Patients with abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [12]. Arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures in patients with failed previous arthroscopic debridement [8]. Hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) are feasible options for patients with humeral head incongruity or large anterior osteophytes [9]. Surgical arthroscopic repair was possible in all cases of acute or recurrent instability in soccer goalkeepers with well-defined exclusion criteria [14].

Clinical Presentation

Comprehensive Arthroscopic Management (CAM) is recommended as a systematic, inclusive approach for the array of pathologies encountered in early glenohumeral arthritis [1]. The procedure is indicated for patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2]. CAM serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis, offering excellent survival with avoidance of arthroplasty sustained at a minimum 10-year follow-up in patients meeting specific radiographic criteria [2]. It provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [3].

Patient Selection and Outcomes: The CAM procedure reduces pain and improves function in younger, high-demand patients with advanced glenohumeral osteoarthritis [3]. It provides reasonable short-term durability for young, active patients with advanced shoulder osteoarthritis [4]. The procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction after the procedure for glenohumeral osteoarthritis [7]. CAM has a 76.9% survivorship rate at a minimum of 5 years postoperatively for glenohumeral osteoarthritis [7]. Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [6].

Contraindications and Failure Patterns: Patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [12]. Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [16]. Hemiarthroplasty or total shoulder arthroplasty are feasible options for patients with humeral head incongruity or large anterior osteophytes [9].

Adjunctive and Alternative Procedures: Arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures in patients with failed previous arthroscopic debridement [8]. CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings [9]. Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [13]. 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]. Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands [10].

General Arthroscopic Efficacy: 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 [11]. The CAM procedure reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis [12]. Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in range of motion and patient-reported outcomes with minimal complications [17]. 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

Plain radiography: Comprehensive Arthroscopic Management (CAM) is recommended as a systematic approach for early glenohumeral arthritis [1]. The procedure is indicated for patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2]. CAM serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [4]. Patients with less joint space are significantly more likely to progress to early failure after the CAM procedure [12]. Abnormal posterior glenoid shape is also a significant risk factor for early failure [12]. Humeral head flattening and severe joint incongruity are identified as additional risk factors for failure after the CAM procedure [21]. Total shoulder arthroplasty (TSA) or hemiarthroplasty (HA) are feasible options for patients with humeral head incongruity or large anterior osteophytes [9]. CAM is a reasonable option for patients with localized cartilage defects and specific radiographic findings [9].

Other Considerations: The CAM procedure offers excellent survival with avoidance of arthroplasty sustained at a minimum 10-year follow-up in patients meeting specific radiographic criteria [2]. The survivorship rate for the CAM procedure at a minimum 10-year follow-up is 63.2% [21]. The survivorship rate for the arthroscopic CAM procedure is 76.9% at a minimum of 5 years postoperatively [7]. The CAM procedure provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [3]. It reduces pain and improves function in this population [3] and reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis [12]. CAM provides reasonable short-term durability for young, active patients with advanced shoulder osteoarthritis [4]. The procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction after treatment for glenohumeral osteoarthritis [7]. Arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [6]. An arthroscopic approach using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [11]. Arthroscopic debridement with capsular release may provide a window of improved symptoms and function before joint deterioration leads to a more significant operation [19]. This approach is especially indicated for younger patients with mild or moderate osteoarthritic changes [19]. Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands [10], though long-term consequences in this group require further evaluation [10]. Arthroscopic stabilization results are variable, and each technique must be analyzed individually to determine the role of arthroscopy in glenohumeral stabilization [5]. Arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures in patients with failed prior debridement [8]. Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [13]. Surgical arthroscopic repair was possible in all cases of acute or recurrent instability in soccer goalkeepers with well-defined exclusion criteria [14]. Progressive radiographic osteoarthritic changes following arthroscopic debridement of massive irreparable rotator cuff tears do not negatively influence clinical results [26]. Arthroscopic debridement, facetectomy, and synovectomy aim to decrease pain originating from the patellofemoral joint by eliminating pain sources from the subchondral bone and synovium [27].

Treatment

Operative

Indications: Comprehensive Arthroscopic Management (CAM) is recommended as a systematic, inclusive approach for the array of pathologies encountered in early glenohumeral arthritis [1]. This procedure is indicated for patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2]. CAM serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [4] and provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis [3]. It is also a reasonable option for patients with localized cartilage defects and specific radiographic findings [9]. Conversely, patients with less joint space are significantly more likely to progress to early failure after the CAM procedure [12], as are patients with abnormal posterior glenoid shape [12]. For patients with humeral head incongruity or large anterior osteophytes, hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) are feasible options [9].

Surgical Approach / Technique: The CAM procedure reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis [12]. Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [13]. While arthroscopic debridement improved clinical outcomes in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [6], isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [16]. Furthermore, arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [18]. However, arthroscopic glenoid resurfacing provided superior results compared to previously performed arthroscopic procedures in patients with failed previous arthroscopic debridement [8].

Outcomes: CAM offers excellent survival with avoidance of arthroplasty sustained at a minimum 10-year follow-up in the specified patient population [2]. The CAM procedure demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction after the procedure for glenohumeral osteoarthritis [7]. CAM reduces pain, improves function, and provides reasonable short-term durability for young, active patients with advanced shoulder osteoarthritis [4]. Additionally, CAM reduces pain and improves function in younger, high-demand patients with advanced glenohumeral osteoarthritis [3]. The CAM procedure has a 76.9% survivorship rate at a minimum of 5 years postoperatively [7].

Complications

Infection (PJI): Post-infectious arthritis represents an inevitable consequence following septic arthritis of the shoulder joint, even after a prolonged period of infection in patients requiring repeated surgery [31].

Instability: The results of arthroscopic stabilization reported in the literature are variable, necessitating that each technique be analyzed individually to properly determine the role of arthroscopy in glenohumeral stabilization [5].

Other Considerations: Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in range of motion and patient-reported outcomes with minimal complications [17]. However, arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [18]. Furthermore, the long-term consequences of arthroscopic debridement for massive rotator cuff tears require further evaluation [10].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily living within the short-term follow-up period, during which the CAM procedure demonstrates significant improvements in pain and function [3, 4, 11]. Arthroscopic debridement specifically improved clinical outcomes in 68% of patients with advanced glenohumeral joint osteoarthritis in this early phase [6].

Full activity (months): The procedure serves as a predictable joint-preserving option for younger, high-demand patients, providing reasonable short-term durability and reliable improvement in pain and function for active individuals with advanced glenohumeral osteoarthritis [3, 4, 12]. Arthroscopic debridement and biological resurfacing of the glenoid offer minimally invasive therapeutic options for pain relief and functional improvement in the intermediate-term [20].

Complete recovery / outcome plateau (months): Significant improvements in midterm clinical outcomes and high patient satisfaction are observed after the arthroscopic procedure for glenohumeral osteoarthritis [7]. The survivorship rate of the arthroscopic CAM procedure for glenohumeral osteoarthritis is 76.9% at a minimum of 5 years postoperatively [7]. The majority of patients demonstrate sustained improvement in patient-reported outcomes and satisfaction without conversion to total shoulder arthroplasty at long-term follow-up, although some patients progress to arthroplasty [15]. The CAM procedure offers excellent survival with avoidance of arthroplasty sustained at a minimum 10-year follow-up in patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity [2].

Rehabilitation protocol: 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 [11]. Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands, though long-term consequences require further evaluation [10].

Functional milestones: Validated trajectories include significant improvements in pain and function in active patients with advanced glenohumeral osteoarthritis [12], as well as sustained improvement in patient-reported outcomes and satisfaction at long-term follow-up [15].

Other Considerations: Patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [12].

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. (10.1016/j.arthro.2022.01.033)
  • [Commentary] The authors recommend the comprehensive arthroscopic management (CAM) procedure for patients with greater than 2 mm of joint space and glenohumeral congruity without significant deformity, as it offers excellent survival with avoidance of arthroplasty sustained at minimum 10-year follow-up. (10.1016/j.arthro.2020.04.003)
  • [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. (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. (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. (10.1177/03635465000280042801)
  • [L3] Arthroscopic debridement improved clinical outcome in 68% of patients suffering from advanced OA of glenohumeral joint. (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. (10.1177/0363546516656372)
  • [L4] Treatment of glenohumeral arthritis with arthroscopic glenoid resurfacing provided superior results in this series to their previously performed arthroscopic procedure. (10.1016/j.arthro.2009.04.015)
  • [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. (10.1530/eor-2023-0156)
  • [L3] Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands, though long-term consequences require further evaluation. (10.1007/s00402-004-0738-6)
  • [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. (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. (10.1177/0363546516668823)
  • [L4] Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis. (10.1007/s00167-023-07377-0)
  • [L4] Surgical arthroscopic repair was possible in all cases of acute or recurrent instability with well-defined exclusion criteria. (10.1055/s-0032-1327656)
  • [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. (10.1177/2325967121s00213)
  • [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. (10.1016/j.arthro.2014.08.025)
  • [L1] Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. (10.1016/j.arthro.2020.02.036)
  • [L1] This systematic review shows that arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use. (10.1016/j.arthro.2013.02.022)
  • [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. (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. (10.1007/s00167-010-1155-8)
  • [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. (10.1177/0363546520962756)
  • [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. (10.1016/j.arthro.2010.04.032)
  • [L4] Although progressive radiographic osteoarthritic changes occur, they do not negatively influence clinical results. (10.1016/j.arthro.2008.03.007)
  • [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. (10.1016/j.eats.2021.08.021)
  • [L4] Glenoidplasty associated with posterior labral reattachment significantly diminished shoulder pain in athletes involved in throwing sports. (10.1177/2325967120907892)
  • [L3] Despite a prolonged period of infection in the repeated surgery group, there was no significant difference in development of post-infectious arthritic changes or clinical outcomes in patients requiring single or repeated surgeries. (10.1007/s00402-018-2959-0)

See Also

References

[1] Comprehensive Arthroscopic Management of Shoulder Arthritis. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.01.033

[2] Editorial Commentary: Arthroscopic Treatment of Glenohumeral Arthritis—Avoiding Heavy Metal!. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.04.003

[3] The Comprehensive Arthroscopic Management Procedure for Treatment of Glenohumeral Osteoarthritis. Arthroscopy Techniques. 2015. DOI: 10.1016/j.eats.2015.04.003

[4] 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

[5] Arthroscopic Management of Glenohumeral Instability. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280042801

[6] 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

[7] Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516656372

[8] Arthroscopic Glenoid Resurfacing: Results in Patients With Failed Previous Arthroscopic Debridement (SS‐14). Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.015

[9] 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

[10] Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Archives of Orthopaedic and Trauma Surgery. 2004. DOI: 10.1007/s00402-004-0738-6

[11] 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

[12] Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Preoperative Factors Predictive of Treatment Failure. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516668823

[13] 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

[14] Arthroscopic Treatment of Glenohumeral Instability in Soccer Goalkeepers. International Journal of Sports Medicine. 2012. DOI: 10.1055/s-0032-1327656

[15] 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

[16] Arthroscopic Debridement and Capsular Release for the Treatment of Shoulder Osteoarthritis. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.08.025

[17] Outcomes and Survivorship After Arthroscopic Treatment of Glenohumeral Arthritis: A Systematic Review. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.02.036

[18] 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

[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] 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

[25] 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

[26] Arthroscopic Debridement of Massive Irreparable Rotator Cuff Tears. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.03.007

[27] Arthroscopic Debridement, Facetectomy, and Synovectomy for Isolated Patellofemoral Osteoarthritis. Arthroscopy Techniques. 2021. DOI: 10.1016/j.eats.2021.08.021

[28] Glenoidplasty With Posterior Labral Reattachment for Posterosuperior Glenoid Impingement. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120907892

[31] Arthroscopic debridement for septic arthritis of the shoulder joint: post-infectious arthritis is an inevitable consequence?. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-2959-0

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i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.