Good afternoon. My name is Dan Haber from Panorama Orthopedics in Colorado. I'd like to thank the conference organizers for this opportunity to speak on the CAM procedure. I'd like to especially acknowledge and recognize my co-authors, particularly Dr. Peter Millett who has pioneered this procedure. Although relatively uncommon, glenohumeral osteoarthritis in young patients can be debilitating. We know from the literature that there are several described surgical techniques to address this difficult problem, specifically arthroscopic debridement. However, it has been shown in the literature to have only short-term benefit and a high conversion to total shoulder arthroplasty. Hemiarthroplasty, biological resurfacing, and Riemann run procedures have also been shown in the literature to have relatively high failure rates and high patient dissatisfaction. Total shoulder arthroplasty in young patients has been shown by Roberson et al. to have a revision rate of 17% at 10 years, and Denard et al. showed us that 38% of young patients with total shoulder arthroplasty at 10 years have loosening at the glenoid. The CAM procedure, or comprehensive arthroscopic management, is a more comprehensive arthroscopic option for these patients. We know that it includes traditional arthroscopic techniques, but also adds inferior humeral osteoplasty, complete capsular release, axillary nerve neurolysis, and biceps tenidesis, and may also include microfracture in appropriate patients. In 2016, Peter Millett et al. reported that the five-year outcomes were quite favorable for the CAM procedure, with survival being 76.9% with high patient satisfaction. The purpose of this study was to report long-term outcomes and survivorship of CAM for glenohumeral osteoarthritis at a minimum 10-year follow-up. We hypothesized that patients would have sustained positive patient-reported outcomes and satisfaction with low conversion to total shoulder arthroplasty at that term. This was a single-surgeon retrospective study. We included patients who otherwise met criteria for total shoulder arthroplasty. We excluded patients with early or mild disease, irreparable rotator cuff pathology, or significant deformity. We also looked at demographics, surgical procedures performed, range of motion, and outcome measures at both 5 and 10 years. We also assessed preoperative x-rays and MRI parameters and defined survivorship as no progression to total shoulder arthroplasty. 38 shoulders in 37 patients had minimum 10-year follow-up. Surgeries were performed between 2006 and 2009. The mean age at the time of surgery was 53 years. CAM survivorship at 5 years was 75%, and at 10 years 63%, meaning that 63% had not progressed to total shoulder arthroplasty. We also assessed risk factors for CAM failure or conversion to total shoulder arthroplasty and found that central flattening and severe joint incongruity as seen in images C and D here were found in 94% of those who had arthroplasty within those 10 years. Otherwise there were no other significant differences in demographics or imaging between patients who did and did not progress to arthroplasty. However it's important to note that some factors may not have been found significant due to the small numbers in this study. Please note also that prior studies have found that joint space less than 2 mm, age greater than 50 years, and WALCH B2 and C glenoids were associated with conversion to total shoulder arthroplasty after CAM. We also found that there were sustained positive patient-reported outcomes and satisfaction at 10 years among those who did not have arthroplasty. Overall there were slight decreases in the SANE score and patient satisfaction between 5 and 10 years, but overall these are still positive results. There are several limitations here. Of course this is a single-surgeon retrospective study. This is a technically challenging procedure. And these procedures were performed in a very active population. And so it begs the question of generalizability. Also could these patients have self-selected against total shoulder arthroplasty? And lastly and likely most importantly, there was no comparison group comparing CAM and TSA. This is an opportunity for future study. In conclusion we found that there were sustained positive patient-reported outcomes and satisfaction at long-term 10-year follow-up after the CAM procedure. We also found that preoperative humeral head flattening and severe joint incongruity was predictive of CAM failure. CAM survival at minimum 10-year follow-up was 63%, which is far superior to typical and simple arthroscopic debridement alone. This suggests that this is an effective joint-preserving alternative to total shoulder arthroplasty or may even be used as a bridging procedure prior to arthroplasty in appropriately selected patients. Thank you.

CAM procedure

glenohumeral osteoarthritis

young patients

arthroscopic techniques

long-term outcomes