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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.

80 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Comprehensive Arthroscopic Management (CAM) is a systematic, inclusive arthroscopic approach indicated for pathologies encountered in early glenohumeral arthritis [2]. It serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [4], providing a predictable short-term option for younger, high-demand individuals [5]. The procedure is also a reasonable next-line treatment when antiinflammatory medications and therapy fail in patients with small, contained, unipolar lesions [11], and it is suitable for those with localized cartilage defects and specific radiographic findings [10]. In patients younger than 50 years, arthroscopic management achieves predictably good to excellent results regardless of tear size [6]. For elderly patients with modest functional demands, arthroscopic debridement remains an excellent treatment [19].

Clinical evidence demonstrates that CAM reliably improves pain and function in active patients with advanced glenohumeral osteoarthritis [1]. Arthroscopic approaches using various joint-preserving procedures reduce pain, improve function, and enhance clinical outcome scores in the short- to mid-term follow-up period [3]. The procedure provides reasonable short-term durability [4] and significant improvements in midterm clinical outcomes with high patient satisfaction [9]. Arthroscopic treatment generally provides improvements in range of motion and patient-reported outcomes with minimal complications [13]. In patients with small, contained, unipolar lesions, arthroscopic debridement yields good short-term results and minimal complications [11]. Arthroscopic debridement improved clinical outcome in 68% of patients suffering from advanced osteoarthritis of the glenohumeral joint [8].

The CAM procedure has a 76.9% survivorship rate at a minimum of 5 years postoperatively [9]. However, patients with less joint space and abnormal posterior glenoid shape are significantly more likely to progress to early failure after the CAM procedure [1]. Isolated arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [28]. For patients with humeral head incongruity or large anterior osteophytes, hemiarthroplasty or total shoulder arthroplasty are feasible options [10]. In a series of patients with failed previous debridement, arthroscopic glenoid resurfacing provided superior results to previously performed arthroscopic debridement [18]. All-arthroscopic techniques for rotator cuff repair have been used with satisfactory results in active duty military personnel [12], and surgical arthroscopic repair was possible in all cases of acute or recurrent instability in soccer goalkeepers with well-defined exclusion criteria [50]. The combined approach of arthroscopic rotator cuff repair and microfracture of the humeral head appears to be a viable joint-preserving option for select patients with concomitant rotator cuff tears and focal humeral head cartilage lesions [24]. The benefits of physeal-sparing transosseous-equivalent arthroscopic rotator cuff repair far exceed those of previously described open procedures without radiographic guidance [29].

Anatomy & Pathophysiology

Glenohumeral Joint Anatomy

The glenohumeral joint is a ball-and-socket articulation where the large humeral head articulates against, but not within, the small glenoid cavity [74]. The glenoid cavity is a shallow socket approximately one-third the size of the humeral head [63]. It is a convex structure of shallow depth shaped like an inverted pear [61]. The subchondral bone of the glenoid is relatively flat, with articular concavity augmented by cartilage and a circumferential labrum [65]. The glenoid averages 5° of retroversion in relation to the axis of the scapular body [65]. The glenoid articular surface radius of curvature is 2 to 3 mm larger than that of the humeral head [74].

The humeral head is spherical with a diameter of 37 to 57 mm [61]. The articular surface of the humeral head is essentially spherical with an arc of approximately 160 degrees covered by articular cartilage [74]. The radius of curvature of the humeral head is approximately 25 mm and is slightly larger in men than in women [74]. The most superior portion of the articular surface of the humeral head averages 8 mm above the greater tuberosity [61]. The superior margin of the humeral head articular surface is normally superior to the top of the greater tuberosity by 8 to 10 mm [74].

Humeral version averages 29.8 degrees with a range of 10 to 55 degrees [61]. The head is inclined approximately 130 degrees with respect to the humeral shaft [61]. The average neck-shaft angle is 45 degrees (±5 degrees) with a range of 30 to 50 degrees [74]. Arthritic shoulders have a flatter neck-shaft angle close to 50 degrees [74]. The humeral head averages 19° of retroversion and 41° of inclination (neck-shaft angle) [65]. The humeral head is retroverted an average of 30 degrees [63]. Proximal humeral retroversion is highly variable, ranging from 0 to 55 degrees depending on the method used for measurement [74].

The distance from the lateral base of the coracoid process to the lateral margin of the greater tuberosity is called the lateral humeral offset [74]. A significant decrease in lateral humeral offset reduces the lever arms for the deltoid and supraspinatus muscles, weakening abduction and impairing function [74]. A significant increase in lateral humeral offset causes excessive tension on soft tissues, resulting in loss of motion and likely accelerating polyethylene wear [74]. Humeral articular malposition of more than 4 mm leads to increased subacromial contact [74]. An offset of 8 mm in any direction significantly decreases passive range of motion [74].

The glenoid labrum is composed of dense fibrocartilaginous tissue and increases the depth of the socket by 50% around the humeral head [75]. The glenoid articular surface and the labrum combine to create a socket that is approximately 9 mm deep in the superoinferior direction and 5 mm deep in the anteroposterior direction [75]. Adding the glenoid labrum increases the glenoid surface to 75% of the humeral head vertically and 57% horizontally [75]. The fibrocartilaginous glenoid labrum deepens the socket by 50% and provides a bumper to translation [76]. The bony anatomy contributes little to stability and has been compared with a golf ball on a tee [75].

The shoulder joint is composed of four articulations: the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic joints [75]. Normal shoulder motion is approximately two-thirds glenohumeral and one-third scapulothoracic [65]. The shoulder joint has the greatest range of motion of any joint in the body [75].

Scapular Anatomy

The scapula is attached to the axial skeleton by the clavicle via the acromioclavicular and sternoclavicular joints [64]. The scapula is suspended by muscles alone and has shifted caudally from the cervical position in lower animals [72]. The basic part of the scapula is the body, which is triangular when viewed anteroposteriorly with its base situated superiorly and its apex inferiorly [64]. The glenoid is connected with the flat body of the scapula by the scapular neck [64]. The hook-shaped coracoid process curves forwards from the superior surface of the scapular neck [64]. The scapular spine ends in a flattened bony process, the acromion, which curves forwards [64].

The highest concentration of bony mass in the scapula is found in the glenoid, the scapular neck (including the base of the coracoid process), and the lateral border of the scapular body [64]. Two bony pillars transmit compressive forces from the glenoid fossa: the lateral pillar and the spinal pillar [64]. The lateral pillar connects the inferior border of the glenoid with the inferior angle [64]. The spinal pillar arises from the central part of the glenoid and continues medially to become part of the base of the scapular spine [64]. The two pillars, connected by a markedly thinner medial border, form the basic load-bearing structure of the scapular body, constituting the biomechanical body of the scapula [64]. The weakest bone in the scapula is located primarily in the central part of the biomechanical body, specifically in the infraspinous fossa [64]. The weakest area of the circumference of the biomechanical body is the connection of the scapular spine and the medial border of the scapula, known as the spinomedial angle [64].

The scapula is anteverted on the chest wall approximately 30 degrees relative to the body [76]. The acromion has three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [65]. Failure of fusion of the acromial ossification centers results in os acromiale [65]. The coracoacromial ligament contributes to anterosuperior stability in rotator cuff deficiency and should be preserved with irreparable cuff tears to prevent anterosuperior escape [76]. The coracoacromial ligament is the arthroscopic landmark for a complete release of the rotator interval for adhesive capsulitis [76].

Proximal Humerus Anatomy

The proximal humerus comprises four main parts: the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft [61]. The anatomic neck of the proximal humerus is located at the junction of the articular surface and the tuberosities [61]. The surgical neck represents an indistinct region (metadiaphyseal junction) below the tuberosities but above the humeral shaft [61]. The greater tuberosity is located in a posterior-superior location with respect to the humeral shaft and serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons [61]. The lesser tuberosity is located on the anterior aspect of the proximal humerus and serves as the attachment site for the subscapularis tendon [61]. The bicipital groove lies between the greater and lesser tuberosities and serves as a pathway for the long head of the biceps [61]. The distal aspect of the bicipital groove is internally rotated with respect to the proximal portion [61].

The proximal humerus has three centers of ossification: the humeral head (4 to 6 months), the greater tuberosity (1 to 3 years), and the lesser tuberosity (3 to 5 years) [65]. The proximal humeral ossification centers fuse to the shaft at age 17 to 20 years [65]. The proximal humeral physis closes by 14 to 17 years of age in girls and by 16 to 18 years in boys [69]. Humeral retroversion averages 65 degrees in infants and young children and gradually decreases, approaching adult values by 11 years of age [69]. The transverse humeral ligament is an important stabilizer of the biceps tendon [76].

Vascular Supply

The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [61]. The posterior humeral circumflex artery travels with the axillary nerve, enters the quadrilateral space posteriorly, and anastomoses with a branch of the anterior circumflex to supply the posterior cuff [61]. The anterior humeral circumflex artery arises from the axillary artery at the inferior border of the subscapularis and provides vascular inflow to the humeral head via its terminal anterolateral branch, the artery of Laing (arcuate artery) [61]. The ascending branch of the anterior humeral circumflex artery courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and greater tuberosity [61]. Injury to the arcuate artery may result in osteonecrosis of the humeral head [61]. Additional extraosseous collateral branches can permit humeral head perfusion despite complete ligation of the arcuate artery [61]. The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [65]. Quantitative assessment has shown that 64% of the humeral head blood supply arises from the posterior humeral circumflex artery [69].

The primary blood supply to the clavicle is periosteal, with no nutrient artery present [65]. The primary blood supply to the clavicle is periosteal, with no nutrient blood supply [71].

Ligaments and Soft Tissue Stabilizers

The rotator cuff stabilizes the glenohumeral joint via joint compression [65]. Static stabilizers of the glenohumeral joint include articular congruity, the glenoid labrum, concavity-compression, negative intra-articular pressure, and the glenohumeral capsule and ligaments [65]. The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [65]. The rotator interval contains the coracohumeral ligament, the superior glenohumeral ligament, and the intra-articular portion of the long head of the biceps tendon [65]. Laxity of the rotator interval results in inferior laxity (the sulcus sign) [65]. Contracture of the rotator interval is seen with adhesive capsulitis [65].

The coracohumeral ligament restricts external rotation in adduction and is a static restraint to inferior and posterior translation in adduction and external rotation [65]. The superior glenohumeral ligament is a primary static restraint against anterior translation with the arm at the side [65]. With the coracohumeral ligament, the superior glenohumeral ligament forms a pulley that provides restraint against medial subluxation of the long head of the biceps tendon [65]. The middle glenohumeral ligament is a primary static restraint against anterior translation with the arm in external rotation and 45° of abduction [65]. The anterior band of the inferior glenohumeral ligament is a primary static restraint against anterior-inferior dislocation of the glenohumeral joint in 90° of abduction and external rotation [65]. The posterior band of the inferior glenohumeral ligament is a primary static restraint against posterior-inferior translation in internal rotation and adduction [65].

The superior glenohumeral ligament is the primary restraint to inferior humeral subluxation in 0 degrees of abduction and is the primary stabilizer to anterior and posterior stress in the same position [75]. The middle glenohumeral ligament limits external rotation when the arm is in the lower and middle ranges of abduction but has little effect when the arm is in 90 degrees of abduction [75]. The inferior glenohumeral ligament is composed of an anterior band, a posterior band, and a thinner intervening axillary pouch, creating a hammock-type sling [75]. The anteroinferior glenohumeral ligament complex is the main stabilizer to anterior and posterior stresses when the shoulder is abducted 45 degrees or more [75]. The middle glenohumeral ligament is absent in up to 30% of shoulders [76].

The superior transverse scapular ligament arises from the medial base of the coracoid overlying the suprascapular notch [65]. The suprascapular artery runs superior to the superior transverse scapular ligament, while the nerve runs deep to the ligament [65]. Entrapment of the suprascapular nerve at the superior transverse scapular ligament causes denervation of both the supraspinatus and the infraspinatus [65]. The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [65]. Entrapment, traction, or compression of the suprascapular nerve at the spinoglenoid notch causes denervation of the infraspinatus [65].

The coracoclavicular ligaments (conoid: medial; trapezoid: lateral) are the primary stabilizers to superior (vertical) translation of the distal clavicle [65]. The posterior SC joint capsule and ligaments are the primary stabilizers to anterior and posterior translation of the medial clavicle [65]. The superior and posterior AC ligaments are the primary stabilizers to anterior and posterior (horizontal) translation of the clavicle [65].

Bursae and Synovial Structures

The subacromial bursa separates the rotator cuff tendons from the coracoacromial arch, allowing them to glide [70]. The subscapular bursa lies between the subscapularis tendon and the neck of the scapula and communicates with the joint cavity between the superior and middle glenohumeral ligaments [66]. The subscapular bursa protects the tendon of the subscapularis at the point where it passes under the base of the coracoid process and over the neck of the scapula [66]. The subscapular bursa often houses loose bodies in the shoulder and is a region where synovitis may be most intense [66]. In 28% of dissected specimens, the subscapular bursae merged with the subcoracoid bursae, forming a unique wide bursa [66].

A soft tissue sheath consistently covers the long head of the biceps tendon to the level of the proximal margin of the pectoralis major tendon and contributes to the roof of the bicipital tunnel [66]. The fibro-osseous bicipital tunnel consists of three distinct anatomic zones: Zone 1 (bony groove), Zone 2 ("no man's land" from distal margin of subscapularis to pectoralis major tendon), and Zone 3 (subpectoral region) [66]. The tendons of the infraspinatus and supraspinatus muscles join approximately 15 mm proximal to their insertion and cannot be readily separated by blunt dissection [75]. The infraspinatus and teres minor fuse near their musculotendinous junctions [75]. The supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove [75]. The roof of the biceps sheath consists of a portion of the supraspinatus tendon, and a sheet of the subscapularis tendon forms the floor [75]. The coracohumeral ligament is a thick band of fibrous tissue extending from the coracoid process along the surface of the capsule to the tuberosities between the supraspinatus and subscapularis tendons [75].

Pathophysiology of Glenohumeral Osteoarthritis

The cause of primary osteoarthritis is unknown, but a genetic predisposition may be present [91]. Secondary causes of osteoarthritis can be posttraumatic, postsurgical, or a result of persistent or recurrent shoulder instability [91]. Posterior glenoid wear and posterior humeral head subluxation occur in up to 45% of shoulders affected by primary osteoarthritis [91]. The anterior soft tissues, including the anterior capsule and the subscapularis, become contracted, limiting external rotation in primary osteoarthritis [91]. Joint space narrowing and periarticular osteophyte formation occur most commonly on the inferior aspects of the humeral head in primary osteoarthritis, a result referred to as a "goat's beard" [91].

Classification

Kellgren-Lawrence: This radiographic classification system is commonly used to assess the severity of glenohumeral osteoarthritis [146].

Samilson–Prieto: This classification system grades preoperative arthritis in glenohumeral osteoarthritis [144].

Walch: The Walch classification categorizes glenoid morphology. Type B2 or C glenoids correlate with unfavorable outcomes for the CAM procedure [15].

Outerbridge: This classification grades articular cartilage degeneration during arthroscopic evaluation [144]. In a systematic review of arthroscopic debridement studies, 79 of 122 patients had Outerbridge grade IV lesions, 21 had grade III, 14 had grade II, and 8 had grade I [144].

Modified Patte: This classification system predicts reparability and tendon healing in arthroscopic rotator cuff repair [152].

Hamada: This classification assesses arthritis in chronic rotator cuff tears [163].

Goutallier: This classification system assesses fatty muscle atrophy [163].

Other Considerations: Less than 2 mm of glenohumeral joint space is a criterion associated with unfavorable outcomes for the CAM procedure [15]. A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology [170].

Clinical Presentation

Patients undergoing Comprehensive Arthroscopic Management (CAM) for glenohumeral osteoarthritis typically present with advanced disease and meet clinical and radiographic criteria for total shoulder arthroplasty [15]. CAM is indicated for patients who elect to undergo a joint-preserving technique to avoid or delay total shoulder arthroplasty [15]. The procedure provides a predictable short-term joint-preserving option for younger, high-demand patients with advanced glenohumeral osteoarthritis by reducing pain and improving function [5]. 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 [41]. 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 [37]. Treating full-thickness symptomatic chondral defects of the glenohumeral joint with microfracture can result in long-term improved function and reduced pain for some patients [22]. Arthroscopic glenoid resurfacing provided superior results to previously performed arthroscopic debridement in patients with glenohumeral arthritis [18]. Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands, though long-term consequences require further evaluation [19]. Arthroscopic management in patients younger than 50 can achieve predictably good to excellent results regardless of tear size [6].

Exclusion Criteria: * Early-stage glenohumeral osteoarthritis (Kellgren-Lawrence grade 1 or 2) [15]. * Patients who have not trialed nonoperative measures [15]. * Irreparable rotator cuff tears [15]. * Severe bipolar chondral lesions with diffuse flattening of the humeral head [15].

Surgical Decision Axes: Total shoulder arthroplasty is suggested over the CAM procedure if patients have a type B2 or C glenoid according to the Walch classification [15]. Total shoulder arthroplasty is suggested over the CAM procedure if patients have less than 2 mm of glenohumeral joint space [15]. Patients with less joint space are significantly more likely to progress to early failure after CAM [1]. Patients with abnormal posterior glenoid shape are significantly more likely to progress to early failure after CAM [1].

Successful management of glenohumeral instability requires a full understanding of all responsible pathologic components, typically involving reattachment of the fibrocartilaginous labrum and re-creating proper tension of the capsuloligamentous structures [14]. In the absence of substantial bone loss, arthroscopic posterior capsulolabral repair remains the gold standard for the surgical management of symptoms refractory to nonoperative treatment [17]. Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head [42]. Approximately 1 in 10 patients with articular-sided, partial-thickness supraspinatus tears (Ellman Grade I) experienced atraumatic tear progression to a symptomatic full-thickness rotator cuff tear and ultimately underwent rotator cuff repair following arthroscopic debridement alongside adjunctive procedures [115].

Investigations

Plain radiography: Standardized plain films are almost always sufficient to establish diagnosis, determine pathoanatomy severity, assist in surgical planning, and illustrate the condition to the patient [31]. The standard shoulder series should include a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [88]. The first key view is the anteroposterior (AP) view in the plane of the scapula, taken so that the x-ray beam passes through the glenohumeral joint [31]. This view shows the superoinferior position of the humeral head relative to the glenoid, presence of osteophytes, joint space narrowing, degree of medial displacement of the humerus, bone quality, loose bodies, and humeral head collapse or deformity [31]. The true AP view in the scapular plane visualizes the anterior greater tuberosity in profile and can reveal proximal humeral migration when the arm is held in neutral rotation with slight abduction [88]. The AP view with the arm in internal rotation visualizes the posterior aspect of the greater tuberosity and the lesser tuberosity in profile [88].

The second key view is the axillary view, taken with the arm in the functional position of elevation in the plane of the scapula [31]. This view is oriented so that both the spinoglenoid notch and the scapular neck are visible [31]. It demonstrates the amount of glenoid bone, shape of the glenoid, its version in relation to the plane of the scapula, and the relationship of the humeral head to the glenoid fossa [31]. Referred to as the "truth view," it demonstrates glenohumeral relationships in the functional position of elevation [31]. Joint space narrowing is most evident on this view as opposed to images made with the arm at the side [31]. The axillary truth view shows posterior subluxation or "functional decentering" that is not evident in images taken with the arm at the side [31]. The degree of posterior subluxation can be measured by the position of the center of the humeral head in relation to the plane of the scapula, the position of the center of the humeral head in relation to the glenoid face, or the point of contact of the humeral articular surface on the glenoid articular surface [31]. The point of contact reflects the degree of centering of the net humeral joint reaction force on the glenoid [31]. Malcentering of the joint reaction force leads to posterior instability, posterior glenoid wear, and "rocking horse" loosening of prosthetic glenoid components [31].

At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction [79]. The axillary projection with the arm in abduction shows the relationship of the humeral head to the glenoid [79]. The axillary view is necessary for evaluation of glenohumeral joint instability and enables determination of humeral head position in the glenoid fossa [88]. It may detect occult, locked posterior shoulder dislocation in a patient who exhibits a lack of passive external rotation [88]. The axillary view is helpful in evaluation of glenoid morphology in glenohumeral osteoarthritis [88]. The scapular Y view provides visualization of the coracoacromial arch and can reveal coracoacromial spurs associated with rotator cuff pathology [88]. It is a reliable alternative for evaluation of glenohumeral subluxation and dislocation [88]. The scapular "Y" view or a Velpeau view must be obtained to evaluate for subluxation or dislocation if the patient is unable to abduct their arm [90]. In a comparison of axillary and scapular "Y" views in 75 consecutive patients with suspected shoulder dislocations, both views resulted in the same diagnosis in 92% of patients [90]. 81% of patients preferred the scapular "Y" view because of less pain [90]. The radiology technician preferred the "Y" view due to the ease of obtaining the image compared to the axillary view [90].

Specific radiographic measurements and morphologies include the acromiohumeral distance, which is normally 7 to 14 mm [88]. The width of the glenohumeral joint space should be symmetric superiorly and inferiorly [88]. The coracoclavicular distance is normally 1.1 to 1.3 cm [88]. Neer classified acromial morphology as type I (flat), type II (curved), and type III (hooked) [88]. Type III acromial morphology has been shown to have a correlation with the presence of rotator cuff disease, but no direct causal relationship has been demonstrated [88]. The Stryker notch view is indicated to evaluate Hill-Sachs lesion after dislocation [88]. The West Point view is indicated for anterior glenoid bone loss [88]. The Zanca view is indicated for the acromioclavicular joint [88]. The apical oblique view is indicated to evaluate for glenoid rim fracture in instability [88]. Radiographs provide an overview of bony anatomy, orientation of the humeral head in relation to the glenoid, and initial assessment for bony Bankart and Hill-Sachs lesions [90]. In a systematic review of posterior shoulder dislocations, 73% of patients had a missed initial diagnosis due to the lack of an axillary view, Y view, or CT imaging [90]. Of the patients with missed initial diagnosis of posterior dislocation, 98% had only AP or lateral views of the shoulder [90]. When axillary or Y-view radiographs were made subsequently, the diagnosis of posterior dislocation was confirmed in 100% of patients [90].

CT: CT scans may offer a few degrees of increased precision in the measurement of glenoid version, but this precision does not improve the quality of the surgery or the clinical outcome [31]. CT scans have the disadvantage of being taken with the arm in the adducted position, unlike the axillary truth view [31]. CT is helpful for planning fracture surgery and shoulder joint replacement [79]. CT imaging is frequently used to evaluate fractures of the shoulder, assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [87]. CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [88]. Three-dimensional sagittal CT scan of the shoulder allows for optimal evaluation of displaced glenoid fractures [88]. Three-dimensional reconstructions based on CT scans of the arthritic shoulder are currently discussed in comparison to imaging consisting only of two standardized plain films [81].

MRI: MRI is useful to identify osteonecrosis of the humeral head, or a bone tumour [79]. MRI can identify labral tears and rotator cuff tears, although the accuracy for these is enhanced by combining the scan with arthrography [79]. MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [87]. T1-weighted MRI can reveal Hill-Sachs lesions and is often used with magnetic resonance arthrograms to provide a more detailed picture of the joint surfaces [87]. T2-weighted MRI provides better visualization of full thickness rotator cuff tears [87]. Traditional MRI is utilized for evaluation of soft tissues with high contrast and spatial resolution in the management of patients with anterior shoulder instability [84]. MR accuracy in identifying labral and rotator cuff tears in the literature ranges from 70% to 100% [84]. Acquired multi-planar imaging allows for the detailed evaluation of the glenoid, labrum, joint capsule, and rotator cuff in different planes [84]. Axial T2-weighted MRI of the shoulder with intra-articular contrast shows anterior labral pathology, with contrast fluid leaking between the glenoid bone and labral tissue consistent with a labral tear [88]. Coronal T2-weighted MRIs of the shoulder can visualize normal rotator cuff insertion, partial-thickness rotator cuff tears, full-thickness nonretracted rotator cuff tears, and massive retracted rotator cuff tears [88]. Sagittal T1-weighted MRIs of the shoulder can visualize normal infraspinatus muscle and fatty infiltration of the infraspinatus muscle [88]. Axial T2-weighted MRI of the shoulder and chest shows a complete tear of the pectoralis major tendon [88]. Axial T2-weighted MRI of the shoulder shows medial dislocation of the biceps tendon, empty bicipital groove, and subscapularis tear [88].

MR Arthrography: MR arthrography refers to MRI of a joint that has been injected with an intra-articular contrast agent such as diluted gadolinium or saline solution [84]. The contrast material is injected prior to MRI by fluoroscopic or ultrasound guidance under strict aseptic technique [84]. By distending the joint capsule, the cartilage, ligaments, and labrum are outlined with contrast, increasing the sensitivity for detecting tears and other lesions [84]. In the acute dislocation setting, a joint effusion with distension of the joint may outline structures similarly, making the arthrogram unnecessary [84]. MR arthrography has proven utility by increasing both sensitivity and specificity in detecting injuries to the capsulolabral-ligamentous complex as compared to traditional MRI [84]. Arthrography involves injection of contrast agent in conjunction with either an MRI or CT scan, enhancing imaging of the joint to enable better identification of normal structures and pathology involving the joint surfaces [87]. MR arthrography is considered the benchmark for evaluation for labral tears and rarely is indicated for evaluation of rotator cuff pathology [87]. When MRI or MR arthrography is contraindicated, such as in patients with a pacemaker or vascular clips, CT arthrography is indicated [87]. In a meta-analysis of 6 studies including 4,667 shoulders, MRA had greater diagnostic test accuracy for glenoid labral lesions than MRI, with MRA sensitivity of 88% and specificity of 93% versus MRI sensitivity of 76% and specificity of 87% [84]. Abduction and external rotation (ABER) of the arm is an alternative position utilized to increase the sensitivity and specificity for detecting anteroinferior labroligamentous injury [84]. Limited range of motion or pain may prohibit patients from performing the ABER provocative maneuver [84]. In a retrospective study, full routine MRI or MRA examination had similar accuracy as the ABER sequence in evaluating the anteroinferior labral-ligamentous complex [84]. In a similar study, the sensitivity of MRA with the ABER position for detecting anteroinferior labral lesions was significantly higher than that of MRA in neutral position and more effective in identifying Perthes lesions [84]. MRAs can demonstrate a patulous capsule on the coronal, sagittal, and axial imaging in patients with multidirectional instability [84]. MRAs can be helpful in evaluating lesions of the rotator interval and other associated findings that may affect the eventual surgical plan [84]. The presence of glenoid dysplasia, increased capsular cross-sectional area, and increased glenoid retroversion have all been found to be associated with increased posterior labral tears and symptomatic instability [84]. Glenoid retroversion was significantly increased in patients with symptomatic posterior labral tears, but there was no significant association between instability and increased humeral head subluxation [84]. The diagnosis of multidirectional instability is a clinical one, and the need for expensive and/or invasive imaging should be weighed against the information that will be gained [84]. Pain relief from corticosteroid injection for prospectively surveyed patients was compared with their magnetic resonance arthrography findings, where findings of adhesive capsulitis and an intact labrum were independent predictors for pain relief [82].

Ultrasonography: Ultrasonography is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [79]. Ultrasonography can be useful in guiding injections or barbotage, which involves aspirating calcific deposits in the rotator cuff [79]. Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [87]. Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [87]. Ultrasonography can be used to measure the subacromial space and detect atrophy of rotator cuff muscles [87]. As a result of providing images in real-time, ultrasonography can evaluate impingement in various positions and motions [87]. Ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [87]. The most commonly performed joint examination using ultrasonography is the shoulder examination [78]. Accuracy of ultrasonography depends on the skill of the scanner operator and an awareness of pitfalls that are encountered [78]. Ten common pitfalls of rotator cuff ultrasonography have been identified to reduce overdiagnosis or underdiagnosis of rotator cuff pathology [78]. Coronal ultrasonographic images can visualize intact and torn supraspinatus tendons [88]. The sensitivity of ultrasonography for the detection of full-thickness rotator cuff tears is 98% [88]. The specificity of ultrasonography for the detection of full-thickness rotator cuff tears is 80% [88]. The positive predictive value of ultrasonography for the detection of full-thickness rotator cuff tears is 90% [88]. The negative predictive value of ultrasonography for the detection of full-thickness rotator cuff tears is 95% [88]. The accuracy of ultrasonography for the detection of full-thickness rotator cuff tears is 94% [88]. The sensitivity of MRI for the detection of full-thickness rotator cuff tears is 100% [88]. The specificity of MRI for the detection of full-thickness rotator cuff tears is 68% [88]. The positive predictive value of MRI for the detection of full-thickness rotator cuff tears is 85% [88]. The negative predictive value of MRI for the detection of full-thickness rotator cuff tears is 100% [88]. The accuracy of MRI for the detection of full-thickness rotator cuff tears is 89% [88].

Arthroscopy: Arthroscopy is useful for diagnosing and treating subacromial impingement, intra-articular lesions, detachment of the glenoid labrum and rotator cuff tears [79]. The MOON Shoulder Group developed and standardized imaging protocols, assembled validated patient-oriented outcome forms, and conducted validation studies on the classification of rotator cuff tears based on MRI and arthroscopy videotapes as well as radiographic findings associated with rotator cuff disease [32].

Treatment

Non-Operative

Nonsurgical modalities constitute the mainstay of management for glenohumeral osteoarthritis in young patients [117]. Any surgical intervention must be preceded by an adequate trial of conservative management, which includes activity modification, physical therapy, antiinflammatory medication, and corticosteroid injections [33]. Injectable viscosupplementation represents an additional nonoperative option, although evidence supporting its use in the shoulder is limited and it is not currently approved by the U.S. Food and Drug Administration for injection in joints other than the knee [33]. Judicious use of nonoperative treatment among patients who would not benefit from such care effectively reduces costs [141].

Operative

Indications: The Comprehensive Arthroscopic Management (CAM) procedure is recommended as a systematic, inclusive approach for the array of pathologies encountered in early glenohumeral arthritis [2]. It serves as a joint-preserving alternative to arthroplasty for young, active patients with advanced shoulder osteoarthritis [4], providing a predictable short-term option for younger, high-demand patients [5]. Arthroscopic treatment is utilized to delay total shoulder arthroplasty in younger, more active patients and those for whom arthroplasty is not an acceptable option [15]. Arthroscopic management is also suitable for elderly patients with significant medical comorbidities who cannot tolerate major surgery [33], and for young patients with early-onset arthritis who are not ideal candidates for arthroplasty due to prosthesis longevity concerns or high functional demands [33]. Indications include persistent pain, stiffness, and weakness despite attempted nonoperative management [130], as well as cases where diagnostic studies reveal only mild arthritic changes despite significant pain, making arthroplasty difficult to justify [33]. Arthroscopy allows for the diagnosis and treatment of coexistent soft tissue pathology, which may eliminate the need for arthroplasty [33]. Patients with MRI-confirmed rotator cuff tears who remain symptomatic after a trial of nonoperative management including nonsteroidal anti-inflammatory drugs, physical therapy, and activity modification are indicated for shoulder arthroscopy and rotator cuff repair [135]. Surgical delay does not improve patient outcomes, and failure to improve with conservative treatment is an indication for surgical intervention [130].

Contraindications and Exclusions: Exclusion criteria for the CAM procedure include early-stage glenohumeral osteoarthritis (Kellgren-Lawrence grade 1 or 2), no trial of nonoperative measures, irreparable rotator cuff tears, and severe bipolar chondral lesions with diffuse flattening of the humeral head [15]. Patients with type B2 or C glenoid morphology according to the Walch classification or less than 2 mm of glenohumeral joint space are counseled that total shoulder arthroplasty is suggested over the CAM procedure [15].

Surgical Approach / Technique: The CAM procedure builds on previously described arthroscopic techniques including debridement, chondroplasty, synovectomy, loose body removal, capsular release, and subacromial decompression [15]. It adds inferior humeral osteoplasty, a complete capsular release, axillary nerve neurolysis, long head of the biceps tenodesis, and microfracture to standard arthroscopic techniques [15]. Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis [21]. Arthroscopic glenoid resurfacing provided superior results to previously performed arthroscopic debridement in patients with failed previous arthroscopic debridement [18]. 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 [37]. All-arthroscopic techniques have been used with satisfactory results for rotator cuff tears in active duty military personnel [12]. Successful management of glenohumeral instability requires reattachment of the fibrocartilaginous labrum and re-creating proper tension of the capsuloligamentous structures [14]. Arthroscopic release resulted in normal motion in all cases of postoperative stiffness following arthroscopic rotator cuff repair [25]. Arthroscopic debridement with microfracture has yielded good-to-excellent results with significant improvements in motion, pain reduction, and high levels of patient satisfaction for unstable, contained osteochondritis dissecans lesions [106].

Preoperative Factors and Prognosis: Glenohumeral osteoarthritis in young patients is associated with higher failure rates after surgical management compared to older patients [117]. Preoperative radiographs and clinical examination are unreliable in predicting osteoarthritis that is documented intraoperatively [33].

Outcomes and Survivorship: The arthroscopic CAM procedure for glenohumeral osteoarthritis demonstrated significant improvements in midterm clinical outcomes and high patient satisfaction, with a 76.9% survivorship rate at a minimum of 5 years postoperatively [9]. Arthroscopic repair was safe and effective in both elderly and younger groups, even for those with massive tears [105]. However, arthroscopic debridement and capsular release may not provide substantial benefit to justify its use in most patients with glenohumeral arthritis [28]. The utility of arthroscopy for treating glenohumeral arthritis is classified as grade I by the American Academy of Orthopaedic Surgeons clinical practice guidelines, implying an inability to recommend for or against this option [33]. A systematic review of the literature showed that arthroscopic debridement for glenohumeral arthritis lacks high-quality evidence to support its routine use [33].

Pain Management: Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair [35]. Following arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills over 6.9 days when used in combination with non-opioid pain medications [145].

Adjuncts: The authors cannot recommend routine use of compressive cryotherapy over standard ice wraps after shoulder arthroscopy [151]. There was no measurable improvement in arthroscopic visualization or early pain scores with the use of tranexamic acid for visualization during arthroscopic rotator cuff repair [7].

Postoperative Rehabilitation: Early active mobilization and early passive mobilization were both safe and beneficial to improve range of motion after arthroscopic surgery for patients with small to large sized tears [114]. Phase-to-phase progression through rehabilitation guidelines is based on achievement of milestones, and if milestones are not reached, collaboration with the referring surgeon should occur to adjust the rehabilitation program [131]. Signs and symptoms suggesting a patient is not ready to advance to the next rehabilitation phase include excessive complaints of pain (≥3 of 10 for phase 1 and ≥2 of 10 for phases 2-4), lack of achievement of the lower range of staged range of motion goals, noncompliance with the home exercise program, and failure to adhere to healing precautions [131]. Complications related to postoperative pain and stiffness are not unexpected after arthroscopic rotator cuff repair, especially in the first 3 months [131]. The primary clinical decision in managing range of motion deficits is to determine whether they are due to excessive pain or true loss of motion [131]. It is not uncommon to experience a slight decrease in range of motion in the late phases of rehabilitation because of increased activity levels, a new focus on strengthening activities, and less time devoted to range of motion exercises [131].

Complications

Stiffness / Arthrofibrosis: Most complications following arthroscopic rotator cuff repair result from significant and persistent stiffness, which resolves without additional operative treatment [173].

Nerve palsy: Complications of the fingers and hand occur easily in patients with a past history of carpal tunnel syndrome or tenosynovitis [171]. These digital complications also occur easily in patients presenting with edema as per a subjective assessment [171].

Other Considerations: Arthroscopic treatment of glenohumeral osteoarthritis is associated with minimal complications [13]. The presence of concurrent glenohumeral osteoarthritis is associated with a significant increase in the odds of both short- and longer-term complications following arthroscopic rotator cuff repair [137]. Suture passing needle breakage is a reported complication associated with the use of specific suturing devices during arthroscopic rotator cuff repair [55].

Recovery

Light activity (weeks): The evidence provided does not specify a typical week range for desk work, driving, or light activities of daily living.

Full activity (months): The evidence provided does not specify a month range for manual work, sport, or full range of motion and strength return.

Complete recovery / outcome plateau (months): The evidence provided does not specify a month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: Patients assigned to early or delayed motion protocols after arthroscopic rotator cuff repair with biceps rerouting show no clinically discernible differences in active range of motion at 1-year follow-up [179]. Similarly, patients in early and delayed postoperative physical therapy groups demonstrate very similar clinical outcomes and range of motion at 1 year after arthroscopic rotator cuff repair [162].

Functional milestones: Patients undergoing primary arthroscopic rotator cuff repair can expect 80% to achieve the Minimal Clinically Important Difference (MCID) and Substantial Clinical Benefit (SCB) within one year [182]. Fifty percent of patients undergoing primary arthroscopic rotator cuff repair achieve Patient Acceptable Symptom Status (PASS) at the one-year time point [182].

Other Considerations: Highly significant clinical improvement of the shoulder was observed in the entire population 2 weeks after arthroscopic debridement of calcific rotator cuff tendinitis [180]. Excellent radiological results were observed until the 9 months follow-up after arthroscopic debridement of calcific rotator cuff tendinitis [180]. Radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair [59]. Clinical differences observed at 2 years between platelet-rich plasma and control groups in arthroscopic rotator cuff repair disappear at long-term follow-up [177]. The clinical and radiological outcomes at the 10-year follow-up show a substantial uniformity of results between platelet-rich plasma and control groups in arthroscopic rotator cuff repair [60, 177].

Key Evidence

• [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. [1] (10.1177/0363546516668823)
• [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. [2] (10.1016/j.arthro.2022.01.033)
• [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. [3] (10.5435/jaaos-d-17-00214)
• [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. [4] (10.1016/j.arthro.2012.10.028)
• [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. [5] (10.1016/j.eats.2015.04.003)
• [L4] Arthroscopic management in patients younger than 50 can achieve predictably good to excellent results regardless of tear size. [6] (10.1016/j.jse.2007.05.006)
• [L2] Additionally, there was no measurable improvement in arthroscopic visualization or early pain scores. [7] (10.1016/j.jse.2022.06.027)
• [L3] Arthroscopic debridement improved clinical outcome in 68% of patients suffering from advanced OA of glenohumeral joint. [8] (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. [9] (10.1177/0363546516656372)
• [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)
• [Paper] Arthroscopic debridement is a reasonable next-line treatment if antiinflammatory medications and therapy fail, with good short-term results and minimal complications in patients with small, contained, unipolar lesions. [11] (10.1016/j.csm.2018.05.003)
• [L4] The authors state they have increasingly used all-arthroscopic techniques with satisfactory results. [12] (10.1053/j.otsm.2005.10.003)
• [L1] Arthroscopic treatment of glenohumeral osteoarthritis provides improvements in ROM and patient-reported outcomes with minimal complications. [13] (10.1016/j.arthro.2020.02.036)
• [L4] Successful management requires a full understanding of all responsible pathologic components, typically involving reattachment of the fibrocartilaginous labrum and re-creating proper tension of the capsuloligamentous structures. [14] (10.1177/03635465000280042801)
• [L3] [15] (10.1177/0363546520962756)
• [L5] In the absence of substantial bone loss, arthroscopic posterior capsulolabral repair remains the gold standard for the surgical management of symptoms refractory to nonoperative treatment, and excellent clinical outcomes have generally been reported. [17] (10.1016/j.arthro.2020.05.018)
• [L4] Treatment of glenohumeral arthritis with arthroscopic glenoid resurfacing provided superior results in this series to their previously performed arthroscopic procedure. [18] (10.1016/j.arthro.2009.04.015)
• [L3] Arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands, though long-term consequences require further evaluation. [19] (10.1007/s00402-004-0738-6)
• [L4] Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis. [21] (10.1007/s00167-023-07377-0)
• [L4] Treating full-thickness symptomatic chondral defects of the glenohumeral joint with microfracture can result in long-term improved function and reduced pain for some patients. [22] (10.1177/0363546517750627)
• [L3] The combined approach appears to be a viable joint-preserving option for select patients with concomitant rotator cuff tears and focal humeral head cartilage lesions. [24] (10.1177/23259671261436439)
• [L4] Arthroscopic release resulted in normal motion in all cases. [25] (10.1016/j.arthro.2009.01.018)
• [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. [28] (10.1016/j.arthro.2014.08.025)
• [Paper] The benefits of this physeal-sparing arthroscopic technique far exceed those of previously described open procedures without radiographic guidance. [29] (10.1016/j.eats.2019.02.012)
• [L1] Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair. [35] (10.1007/s00167-012-2202-4)
• [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. [37] (10.1007/s00167-010-1155-8)
• [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. [41] (10.1016/j.arthro.2006.11.016)
• [L5] Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head. [42] (10.2106/jbjs.rvw.23.00243)
• [L4] Surgical arthroscopic repair was possible in all cases of acute or recurrent instability with well-defined exclusion criteria. [50] (10.1055/s-0032-1327656)
• [L4] This is the first reported complication associated with the use of this type of suturing device, highlighting the need for careful examination of all devices during and after arthroscopic surgery. [55] (10.1016/j.arthro.2007.10.010)
• [L3] Radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. [59] (10.1177/23259671221126095)
• [L2] The clinical and radiological outcomes at the 10-year follow-up show a substantial uniformity of results between the 2 groups. [60] (10.1016/j.arthro.2021.05.017)
• [L3] Arthroscopic repair was safe and effective in both groups, even for those with massive tears. [105] (10.1016/j.jse.2018.10.010)
• [Paper] Arthroscopic debridement with microfracture has yielded good-to-excellent results with significant improvements in motion, pain reduction, and high levels of patient satisfaction. [106] (10.1016/j.eats.2020.01.001)
• [L1] EAM and EPM were both safe and beneficial to improve ROM after arthroscopic surgery for patients with small to large sized tears. [114] (10.1186/s12891-023-07075-5)
• [L4] Despite improvements in pain relief and functional outcomes, approximately 1 in 10 patients experienced atraumatic tear progression to a symptomatic full-thickness rotator cuff tear and ultimately underwent rotator cuff repair. [115] (10.1002/ars2.70011)
• [L5] Glenohumeral osteoarthritis in young patients is a difficult condition with higher failure rates after surgical management compared to older patients; nonsurgical modalities are the mainstay of management, while surgical options include arthroscopic débridement, humeral head replacement, and total or reverse total shoulder arthroplasty. [117] (10.5435/jaaos-d-16-00657)
• [Paper] [130] (10.1016/j.eats.2016.04.002)
• [L5] [131] (10.1016/j.jse.2015.12.018)
• [Paper] [135] (10.1016/j.eats.2020.06.013)
• [L3] The presence of concurrent glenohumeral osteoarthritis was associated with a significant increase in the odds of both short- and longer-term complications following ARCR. [137] (10.1016/j.xrrt.2025.100659)
• [L3] Judicious use of nonoperative treatment modalities among patients who would not benefit from nonoperative care will be an effective way of reducing costs. [141] (10.1177/2325967120937016)
• [L1] [144] (10.1016/j.arthro.2013.02.022)
• [L2] Following arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills over 6.9 days when used in combination with non-opioid pain medications. [145] (10.1016/j.asmr.2021.10.005)
• [L4] [146] (10.1016/j.xrrt.2026.100778)
• [L2] The authors cannot recommend routine use of compressive cryotherapy over standard ice wraps after shoulder arthroscopy. [151] (10.1016/j.jse.2015.02.004)
• [L3] The modified Patte classification system can be easily implemented in clinical practice for planning surgical procedures and counselling patients in the day‐by‐day clinical work. [152] (10.1002/ksa.12162)
• [L1] Patients in the early and delayed groups demonstrated very similar clinical outcomes and range of motion at 1 year. [162] (10.1016/j.jse.2012.01.025)
• [L1] [163] (10.1177/0363546519843910)
• [L3] A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology. [170] (10.1016/j.jse.2021.01.018)
• [L2] Complications of the fingers and hand after arthroscopic rotator cuff repair easily occurred in patients with a past history of carpal tunnel syndrome or tenosynovitis and in patients with edema as per a subjective assessment. [171] (10.1016/j.jseint.2021.07.001)
• [L4] Most complications were a result of significant and persistent stiffness that resolved without additional operative treatment. [173] (10.1016/j.arthro.2006.09.001)
• [L1] The clinical and radiological outcomes at the 10-year follow-up show a substantial uniformity of results between the two groups, with clinical differences observed at 2 years disappearing at long term. [177] (10.1177/2325967121s00245)
• [L1] This study's findings reveal no clinically discernible differences in active range of motion at 1-year follow-up between patients assigned to either early or delayed motion protocols. [179] (10.1016/j.jse.2024.01.029)
• [L1] Highly significant clinical improvement of the shoulder was already observed in the entire population 2 weeks after surgery, with excellent radiological results observed until the 9 months follow-up. [180] (10.1007/s00402-014-1927-6)
• [L3] This study established the timeline to reach MCID, SCB and PASS in patients undergoing primary arthroscopic RCR. 80% of patients can expect to achieve MCID and SCB within one year, while 50% achieve PASS at this time point. [182] (10.1177/2325967119s00442)

See Also

• Capsular Release for Frozen Shoulder
• Total shoulder arthroplasty
• Rotator cuff repair
• Rotator Cuff
• Os Acromiale
• Shoulder Instability
• Shoulder Arthroplasty
• Fractures
• Shoulder Arthritis
• Calcific Tendinitis
• Shoulder Arthroscopy
• Subacromial Decompression
• Biceps Tenodesis

References

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

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

[3] 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

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

[6] Arthroscopic rotator cuff repair in patients younger than fifty years of age. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.05.006

[7] The effect of tranexamic acid for visualization on pump pressure and visualization during arthroscopic rotator cuff repair: an anonymized, randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.06.027

[8] 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

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

[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] Nonarthroplasty Options for the Athlete or Active Individual with Shoulder Osteoarthritis. Clinics in Sports Medicine. 2018. DOI: 10.1016/j.csm.2018.05.003

[12] Arthroscopic Rotator Cuff Repair in Active Duty Military Personnel: A Young Cohort of Patients with Rotator Cuff Tears. Operative Techniques in Sports Medicine. 2005. DOI: 10.1053/j.otsm.2005.10.003

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

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

[15] 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

[17] Posterior Glenohumeral Instability: Diagnosis and Management. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.05.018

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

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

[21] 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

[22] Long-term Clinical Outcomes After Microfracture of the Glenohumeral Joint: Average 10-Year Follow-up. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546517750627

[24] Midterm Outcomes of Concomitant Arthroscopic Rotator Cuff Repair and Microfracture of Humeral Head, Focal, Full-thickness Cartilage Lesions. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261436439

[25] Incidence and Treatment of Postoperative Stiffness Following Arthroscopic Rotator Cuff Repair. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.01.018

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

[29] Physeal‐Sparing Transosseous‐Equivalent Arthroscopic Rotator Cuff Repair. Arthroscopy Techniques. 2019. DOI: 10.1016/j.eats.2019.02.012

[31] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[32] Orthopaedic Knowledge Update Sports Medicine 6. Research Studies and Registries in Sports Medicine > Multicenter and Registry-­Based Research in Sports Medicine > Shoulder Research.

[33] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > INDICATIONS FOR ARTHROSCOPIC TREATMENT.

[35] Randomized, controlled trial of multimodal shoulder injection or intravenous patient‐controlled analgesia after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2202-4

[37] Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1155-8

[41] Arthroscopic Debridement and Capsular Release for Glenohumeral Osteoarthritis. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.016

[42] Management of Bone Loss in Posterior Glenohumeral Shoulder Instability. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00243

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

[55] Suture Passing Needle Breakage During Arthroscopic Rotator Cuff Repair: A Complication Report. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2007.10.010

[59] Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221126095

[60] Platelet‐Rich Plasma in Arthroscopic Rotator Cuff Repair: Clinical and Radiological Results of a Prospective Randomized Controlled Trial Study at 10‐Year Follow‐Up. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.05.017

[61] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[63] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > SHOULDER AND ARM INJURIES.

[64] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[65] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[66] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[69] Rockwood And Matsen S The Shoulder. Fractures, Dislocations, and Acquired Problems of the Shoulder in Children > FRACTURES OF THE PROXIMAL HUMERUS.

[70] Apley And Solomon S Concise System Of Orthopaedics And Trauma. DISORDERS OF THE ROTATOR CUFF.

[71] Aaos Comprehensive Orthopaedic Review 3. Fractures of the Clavicle, Scapula, and Glenoid > I. Clavicular Fractures.

[72] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Development of Individual Regions.

[74] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTIVE PROCEDURES OF THE SHOULDER AND ELBOW IN ADULTS > ANATOMY AND BIOMECHANICS.

[75] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE-PATELLAR TENDON-BONE GRAFT > SHOULDER INJURIES > ANATOMY AND BIOMECHANICS.

[76] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > UPPER EXTREMITY > SHOULDER.

[78] Orthopaedic Knowledge Update Sports Medicine 6. Diagnostic Ultrasonography and Ultrasonography-­Guided Procedures > Annotated References.

[79] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[81] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[82] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Glenohumeral Joint > Annotated References.

[84] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Magnetic Resonance Imaging and Arthrography.

[87] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging > Clinical Evaluation > Imaging.

[88] Aaos Comprehensive Orthopaedic Review 3. Imaging of the Shoulder and Elbow > I. Shoulder.

[90] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Radiography.

[91] Aaos Comprehensive Orthopaedic Review 3. Arthritis and Arthroplasty of the Shoulder* > I. Osteoarthritis.

[105] Do elderly patients gain as much benefit from arthroscopic rotator cuff repair as their younger peers?. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.010

[106] Technique for Arthroscopic Debridement and Microfracture of Unstable, Contained Osteochondritis Dissecans Lesions of the Capitellum. Arthroscopy Techniques. 2020. DOI: 10.1016/j.eats.2020.01.001

[114] Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-07075-5

[115] Excellent Outcomes and High Rates of Return to Duty but a 10% Chance of Tear Progression Are Seen Following Arthroscopic Debridement Alongside Adjunctive Procedures for Articular‐Sided, Partial‐Thickness Supraspinatus Tears (Ellman Grade I) in Active‐Duty Service Members Younger Than 50 Years. Arthroscopy, Sports Medicine, and Rehabilitation. 2026. DOI: 10.1002/ars2.70011

[117] Glenohumeral Osteoarthritis in the Young Patient. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00657

[130] Arthroscopic Rotator Cuff Repair With Concomitant Capsular Release. Arthroscopy Techniques. 2016. DOI: 10.1016/j.eats.2016.04.002

[131] The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.018

[135] Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Minced Autologous Subacromial Bursa. Arthroscopy Techniques. 2020. DOI: 10.1016/j.eats.2020.06.013

[137] Outcomes following arthroscopic rotator cuff repair adversely affected by underlying diagnosis of glenohumeral osteoarthritis: a matched cohort analysis. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100659

[141] Health Care Utilization and Costs in the Year Prior to Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120937016

[144] 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

[145] Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.10.005

[146] Comprehensive arthroscopic management procedure and autologous microfragmented adipose tissue infiltration in mild-to-moderate glenohumeral osteoarthritis: two-year follow-up outcomes. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100778

[151] Compressive cryotherapy versus ice—a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.02.004

[152] A modified Patte classification system for rotator cuff tendon retraction to predict reparability and tendon healing in arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12162

[162] Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.01.025

[163] Is It Safe to Inject Corticosteroids Into the Glenohumeral Joint After Arthroscopic Rotator Cuff Repair?. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519843910

[170] Determination of predisposing scapular anatomy with a statistical shape model—Part II: shoulder osteoarthritis. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.01.018

[171] Risk factors related to complications of the fingers and hand after arthroscopic rotator cuff repair – carpal tunnel syndrome, flexor tenosynovitis, and complex regional pain syndrome. JSES International. 2021. DOI: 10.1016/j.jseint.2021.07.001

[173] Complications After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.09.001

[177] Platelet Rich Plasma in Arthroscopic Rotator Cuff Repair: Clinical and Radiological Results of A Prospective RCT Study at 10-Year Follow-Up. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00245

[179] Does timing influence rehabilitation outcomes in arthroscopic rotator cuff repair with biceps rerouting? a prospective randomized study. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.01.029

[180] The intraoperative use of ultrasound facilitates significantly the arthroscopic debridement of calcific rotator cuff tendinitis. Archives of Orthopaedic and Trauma Surgery. 2014. DOI: 10.1007/s00402-014-1927-6

[182] Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00442