Biologic options for treatment of cartilage lesions at the shoulder joint Technique, indications and limits

The treatment of focal cartilage defects confronts the shoulder surgeon with several challenges. It is often an incidental finding that occurs in combination with other pathologies, particularly in the shoulder joint. In addition, the preoperative diagnostics are often insufficient in the routine practice to clearly show the exact extent of cartilage lesions. Ultimately, the evidence base with respect to possible treatment options is still extremely weak. Only studies with very low case numbers and short follow-up are available. A further complicating factor is that many lesions are already evidence of an early osteoarthritis or the combined pathology was addressed in these studies, making it difficult to derive clear strategies; however, modern arthroscopic procedures enable promising forms of treatment that can be applied in a minimally invasive way and may even provide the possibility of formation of cartilage replacement tissue.