Treatment of Shoulder Cartilage Defects in Athletes

Background: Shoulder cartilage defects are a significant concern for athletes, especially those involved in overhead sports like baseball, tennis, and swimming. These defects can result from acute injuries, repetitive trauma, or degenerative changes, leading to pain, reduced range of motion, and functional impairment. The glenohumeral joint cartilage has limited healing capacity due to its avascular nature, making effective treatment crucial for restoring joint function and allowing athletes to return to their sport. Various treatment options exist, ranging from conservative management to advanced surgical techniques. Understanding these options and their outcomes is essential for optimizing recovery in athletic populations. Methods: This study examines the current literature on the treatment of shoulder cartilage defects in athletes. The authors evaluated various therapeutic approaches for focal cartilage lesions in the glenohumeral joint. This review focused on non-surgical interventions, such as physical therapy and injections, as well as surgical techniques, including arthroscopic débridement, microfracture, osteochondral autograft transfer (OATS), and autologous chondrocyte implantation (ACI). Key factors affecting treatment outcomes, including defect size, location, patient age, activity level, and any related shoulder pathology, were also evaluated. Results: The findings highlight a range of treatment options available for shoulder cartilage defects, each with specific indications based on defect characteristics and individual athlete factors. Non-surgical approaches like physical therapy and corticosteroid injections were often effective for smaller defects or injuries in the early stages. For larger or symptomatic defects, surgical options such as microfracture and OATS were typically employed. Microfracture showed promising short-term results but often led to fibrocartilage instead of durable hyaline cartilage. ACI emerged as a favorable option for larger lesions due to its potential for better long-term outcomes; however, it requires more extensive rehabilitation and incurs higher costs. This review demonstrates that successful outcomes depend on thorough preoperative assessment and adherence to postoperative rehabilitation protocols. Overall, return-to-play rates significantly varied based on the surgical technique used and the athlete's compliance with rehabilitation. Conclusion: Effective management of shoulder cartilage defects in athletes requires a comprehensive understanding of the various treatment options available. While both non-surgical and surgical interventions can be effective, their success largely depends on individual patient factors such as defect size and related injuries. Early intervention is critical to prevent further joint degeneration and facilitate optimal recovery. Future research should focus on enhancing existing techniques and exploring innovative treatments that can improve cartilage repair while addressing the high demands of athletes' shoulders.