HYPOTHESIS: Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications. MATERIALS AND METHODS: Twenty three cases of post-arthroscopic glenohumeral chondrolysis, occurring between 2005-2006, are reported following a variety of arthroscopic shoulder procedures. Presenting complaints, signs and symptoms, associated operative findings, and potential etiological factors are reviewed. Management options are summarized. RESULTS: Of the 23 cases of chondrolysis identified in our practice over a two year period, 14 occurred in patients following labral repair using a bioabsorbable device. Seventeen of the 23 patients used a high volume intra-articular pain pump for 48 hours after surgery. Seven of the 23 cases had documented use of a thermal probe. Four cases occurred in shoulders with no reported use of fixation anchors, pain pumps, or thermal probes. All cases had at least a 20 cc intra-articular bolus injection of 0.25% bupivicaine with epinephrine. DISCUSSION: This case series identifies several common factors that could be responsible for post-arthroscopic glenohumeral chondrolysis. No single mechanism can be implicated based on the results of this study. Although strong concerns are raised over the use of intra-articular local anesthetics, glenohumeral chondrolysis appears to be an unfortunate convergence of multiple factors that may initiate rapid dissolution of articular cartilage and degenerative changes. CONCLUSION: Chondrolysis is a devastating complication of arthroscopic shoulder surgery that can result in long-term disabling consequences. Further research is required to specifically identify causative factors. Until this is a available, we strongly advise against the use of large doses of intra-articular placement of local anesthetics.
HYPOTHESIS: Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications. MATERIALS AND METHODS: Twenty three cases of post-arthroscopic glenohumeral chondrolysis, occurring between 2005-2006, are reported following a variety of arthroscopic shoulder procedures. Presenting complaints, signs and symptoms, associated operative findings, and potential etiological factors are reviewed. Management options are summarized. RESULTS: Of the 23 cases of chondrolysis identified in our practice over a two year period, 14 occurred in patients following labral repair using a bioabsorbable device. Seventeen of the 23 patients used a high volume intra-articular pain pump for 48 hours after surgery. Seven of the 23 cases had documented use of a thermal probe. Four cases occurred in shoulders with no reported use of fixation anchors, pain pumps, or thermal probes. All cases had at least a 20 cc intra-articular bolus injection of 0.25% bupivicaine with epinephrine. DISCUSSION: This case series identifies several common factors that could be responsible for post-arthroscopic glenohumeral chondrolysis. No single mechanism can be implicated based on the results of this study. Although strong concerns are raised over the use of intra-articular local anesthetics, glenohumeral chondrolysis appears to be an unfortunate convergence of multiple factors that may initiate rapid dissolution of articular cartilage and degenerative changes. CONCLUSION: Chondrolysis is a devastating complication of arthroscopic shoulder surgery that can result in long-term disabling consequences. Further research is required to specifically identify causative factors. Until this is a available, we strongly advise against the use of large doses of intra-articular placement of local anesthetics.
Authors: Paritosh Gogna; Paolo Paladini; Giovanni Merolla; Carlo Alberto Augusti; De Falco Maddalena; Giuseppe Porcellini Journal: Musculoskelet Surg Date: 2016-11-30
Authors: Nicole A Friel; Vincent M Wang; Mark A Slabaugh; FanChia Wang; Susan Chubinskaya; Brian J Cole Journal: J Shoulder Elbow Surg Date: 2012-07-20 Impact factor: 3.019