Midterm Outcomes of Concomitant Arthroscopic Rotator Cuff Repair and Microfracture of Humeral Head, Focal, Full-thickness Cartilage Lesions

Background: The treatment of full-thickness cartilage lesions of the humeral head in active-duty servicemembers (ADSMs) who have concomitant full-thickness rotator cuff tears and focal cartilage lesions of the humeral head is uncommon and presents clinical challenges. Purpose: To compare the midterm clinical and functional outcomes of ADSMs who underwent isolated arthroscopic rotator cuff repair (ARCR) with those who underwent ARCR and concomitant humeral head microfracture (HHMfx) for focal, full-thickness cartilage lesions of the humeral head. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective analysis of ADSMs from a single duty-station who underwent ARCR for full-thickness rotator cuff tears between January 2014 and June 2019 with a minimum follow-up of 5 years. Patients who underwent ARCR + HHMfx were compared with those who underwent isolated ARCR based on outcome measures including the visual analog scale (VAS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Statistical analysis was performed using paired t tests to compare preoperative and postoperative outcomes. Minimal clinically important difference (MCID) was also evaluated, but not Patient Acceptable Symptom State or substantial clinical benefit due to the small sample size. Results: A total of 74 patients were eligible for inclusion, with 22 undergoing ARCR + HHMfx and 52 undergoing isolated ARCR. Significant postoperative improvements were observed in all patient-reported outcome measures ( P < .0001 for all). Comparisons between the 2 cohorts demonstrated no significant differences in VAS pain scores (0.9 ± 1.6 vs 0.6 ± 1.0, respectively; P = .3045) but significantly improved SANE (90.2 ± 10.7 vs 95.1 ± 6.5; P = .0178) and ASES (91.7 ± 10.9 vs 96.1 ± 5.9; P = .0293) scores in the isolated ARCR group. Among patients in the ARCR + HHMfx group, MCID achievement rates were 90.9% (n = 20) for VAS, 77.3% (n = 17) for SANE, and 95.5% (n = 21) for ASES. All patients within the isolated ARCR group met the MCID thresholds for VAS, SANE, and ASES scores. Range of motion improved, although changes in forward flexion, external rotation, and internal rotation were not statistically significant ( P > .05 for all). At the final follow-up, 20 (90.9%) patients in the ARCR + HHMfx group and 48 (92.3%) patients in the ARCR group returned to preinjury work and activity levels ( P > .9999). Similarly, 19 (86.4%) patients in the ARCR + HHMfx group and 46 (88.5%) patients in the ARCR group returned to preinjury sports participation ( P > .999). One patient (4.6%) in the ARCR + HHMfx group and 2 patients (3.9%) in the ARCR group progressed to total shoulder arthroplasty (TSA). Other complications included stiffness in 1 patient (1.9%) in the ARCR group and retear in 3 patients (5.8%) in the ARCR group. Conclusion: ARCR + HHMfx resulted in significant improvements in pain, function, and patient-reported outcomes at midterm follow-up that were comparable to outcomes for isolated ARCR. Although return-to-work and return-to-sport rates were slightly higher with the isolated ARCR group, this did not reach statistical significance, and the 95% TSA-free survival rate suggests that this combined approach appears to be a viable joint-preserving option for select patients with concomitant rotator cuff tears and focal humeral head cartilage lesions. However, study limitations include the retrospective design, small sample size, and heterogeneity introduced by concomitant procedures.