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

Abstract

In young patients, the management of glenohumeral osteoarthritis (OA) is particularly difficult. Although it has been well established that total shoulder arthroplasty (TSA) improves pain and function in most patients with glenohumeral OA, surgical treatment of young, active patients with TSA is less favorable owing to accelerated component wear and loosening of the glenoid component which necessitates subsequent revision TSA. As such, joint preservation is an attractive option for this patient population as a method to delay arthroplasty and to reduce the number of revision procedures that would be needed throughout patients’ lives. The comprehensive arthroscopic management (CAM) procedure is a palliative measure meant to address known pain generators within the shoulder and has been shown to decrease pain and improve function in young patients with glenohumeral OA while also delaying the need for TSA. The procedure involves glenohumeral debridement and chondroplasty, humeral head osteoplasty, capsular releases, and axillary nerve neurolysis. Additional procedures such as microfracture and biceps tenodesis are also performed when indicated. 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.