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Treatment Alternatives

In the past, the most common treatment for many if not most of the articular cartilage lesions that were seen in the shoulder (and other joints) was simple debridement and symptomatic management. Today’s aim, however, is to restore durable hyaline cartilage through a practical and minimally invasive approach (preferably arthroscopic), that is associated with minimal morbidity perioperatively and in the long term.

There are several avenues available to accomplish the restoration of articular cartilage; however, most of the literature has been focused on knee joint abnormalities, with less attention to the other joints. The variety of techniques includes autogenous tissues, allograft tissues, and synthetic components.

In addition, simple debridement of the area of degeneration with subchondral stimulation is used on a routine basis. Although the use of this technique has not been explicitly studied in the literature with respect to the shoulder, the principles of stimulation of the subchondral area for creation of a fibrocartilaginous layer over the diseased area should also apply. This technique will be discussed in more detail in a later section of this chapter.

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