The Comprehensive Arthroscopic Management (CAM) Procedure for Young Patients with Glenohumeral Osteoarthritis

Authors:

Peter J Millett, Marilee P Horan, Andrew T Pennock, Daniel Rios

Abstract:

Glenohumeral osteoarthritis (OA) is a common condition typically associated with increasing age and often previous trauma. Patients typically present in later stages with generalized shoulder pain due to degeneration of articular cartilage with limited active and passive range of motion as a result of capsular contractures. There are many potential causes of glenohumeral OA (e.g., posttraumatic or iatrogenic); however, the majority of cases are idiopathic in nature.

Although glenohumeral OA is most commonly observed in the aging population, younger patients can still be afflicted with the condition. As a referral practice, we have seen a particularly large number of younger patients (e.g., <60 years of age) with glenohumeral OA who prefer to either avoid or delay arthroplasty using a joint- preserving approach.

The rationale to pursue joint preservation is based upon the limitations and risks currently associatedwithtotalshoulderarthroplasty(TSA) in young patients. Specifically, it is well known that the clinical outcomes and patient satisfaction following TSA are less favorable in patients younger than 50 years of age. This effect is perhaps due to the fact that younger patients are more likely to engage in higher-demand activities and are generally more active. Due to limited implant longevity, TSA in younger patients may necessitate revision TSA which, in itself, is also known to produce less optimal outcomes when compared to primary TSA. Thus, the risk for failure after TSA is particularly elevated in those who participate in higher-demand activities which may accelerate polyethylene wear and lead to implant loosening.

Arthroscopic joint preservation is considered a palliative measure designed to address known and treatable pain generators in the shoulder in order to alleviate symptoms and either delay or prevent the need for future arthroplasty. The comprehensive arthroscopic management (CAM) procedure involves glenohumeral debridement and chondroplasty, humeral head osteoplasty, capsular releases, and axillary nerve neurolysis. Microfracture, subacromial decompression with or without acromioplasty, and biceps tenodesis are also performed when necessary. Preliminary results of this procedure have been encouraging. The purpose of this chapter is to describe and illustrate the CAM procedure in detail and to review the clinical results following arthroscopic joint-preserving approaches for glenohumeral OA.

For the complete study: The Comprehensive Arthroscopic Management (CAM) Procedure for Young Patients with Glenohumeral Osteoarthritis

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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The Comprehensive Arthroscopic Management (CAM) Procedure for Young Patients with Glenohumeral Osteoarthritis

Authors:

Abstract:

About the Author: Peter Millett, MD