Chondral and Osteochondral Lesions of the Humerus: Diagnosis and Management

Chondral and osteochondral injuries to the humeral head are common in the setting of shoulder instability and often contribute to recurrent instability. Such lesions also may result from high-energy trauma, avascular necrosis, infection, and iatrogenic causes. Although small lesions may be successfully managed nonoperatively, there are expanding indications for the surgical management of symptomatic chondral and osteochondral lesions of the humeral head. We will review the etiologies of such lesions and the most current and effective diagnostic and treatment strategies. This work also provides concise, but detailed, guidelines and technical pearls for the most common surgical techniques for managing focal and extensive chondral and osteochondral lesions of the humeral head, including microfracture, allograft and autograft osteoarticular transplant grafts, autologous chondrocyte implantation, transhumeral disimpaction with bone grafting, structural allograft reconstruction, and soft-tissue transfers, such as remplissage and lesser tuberosity transfers. We also include pertinent evidenced-based literature in the support of each of these approaches. This review is intended to serve as a helpful resource to orthopedic surgeons managing the challenges of symptomatic chondral and osteochondral lesions of the humeral head.