Microfracture for glenohumeral cartilage defects: Short- to mid-term results. A systematic review and meta-analysis.

Abstract

Articular cartilage defects of the glenohumeral joint are challenging in young, active patients, where microfracture-a common first-line marrow-stimulation technique-has uncertain efficacy and long-term durability in the shoulder. This study evaluates the clinical outcomes of patients undergoing treatment with microfracture for chondral lesions of the glenohumeral joint. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane Library were searched through January 2026. Patient-reported outcomes (PROs), reoperation rates, complications, and radiographic outcomes were assessed. Eight Level IV studies comprising 171 shoulders met the inclusion criteria. Mean age was 50.4 years with a 97.5-month follow-up. Significant improvements occurred in the American Shoulder and Elbow Score (+20.3 points), Visual Analogue Scale for pain (-2.2 points), and Single Assessment Numeric Evaluation scores. Pooled reoperation rate was 20.9% (95% CI 14.2-29.7%). No procedure-related complications were reported. Two studies noted radiographic progression of osteoarthritis despite clinical improvement. Microfracture provides consistent short- to mid-term improvements in PROs and appears safe for glenohumeral cartilage defects. However, the evidence is limited to Level IV studies, and concerns remain regarding long-term durability and progression of osteoarthritis.