Glenohumeral Chondrolysis After Arthroscopy: A Systematic Review of Potential Contributors and Causal Pathways

Management of complications after rotator cuff surgery

“…As the popularity of the arthroscopic treatment of shoulder pathology has risen over the last 15 years, glenohumeral chondrolysis has been better recognized as a complication of arthroscopic shoulder surgery [52]. Specifically, it has been commonly associated with arthroscopic thermal devices, intra-articular local anesthetic, and proud intra-articular anchor placement [53,54]. Solomon et al [54] identified 88 cases of postarthroscopic glenohumeral chondrolysis (PAGCL) in the literature in order to determine risk factors.…”

“…Specifically, it has been commonly associated with arthroscopic thermal devices, intra-articular local anesthetic, and proud intra-articular anchor placement [53,54]. Solomon et al [54] identified 88 cases of postarthroscopic glenohumeral chondrolysis (PAGCL) in the literature in order to determine risk factors. While the majority of the diagnoses in this series were instability (32 %) or superior labrum anterior to posterior (SLAP) tears (23 %), the authors found 10 % (9/91) of these shoulders involved a partial or full thickness rotator cuff tear.…”

Inhibition of Chondrocyte and Synovial Cell Death After Exposure to Commonly Used Anesthetics

“…9,10,[12][13][14][15][16][17]29,34 The potentially catastrophic clinical effects of local anesthetics on articular cartilage were first described in the shoulder, where the use of intra-articular pumps designed to deliver these agents after arthroscopic surgery to mitigate pain was shown to be associated with severe cartilage loss in some cases, termed postarthroscopic glenohumeral chondrolysis (PAGCL). 27,45,51,54 In addition to the overt cartilage damage observed at the time of surgery in these patients, there was also profound damage to the synovial tissue of the joint capsule, likely caused by anesthetic exposure. However, it is unclear whether anesthetics are toxic to synovial cells and whether apoptosis pathways play a role in synovial cell death.…”

Local Anesthetic Agents in Arthroscopy

“…The potential for deleterious effects of local anesthetic agents on articular chondrocytes was increasingly noted with the use of arthroscopic pain pumps following glenohumeral arthroscopy (Busfield and Romero, 2009, Hansen et al, 2007, Solomon et al, 2009. Increasingly however studies are alerting the practicing clinician to the potential for toxic effects secondary to amide local anesthetics given as a single bolus injection.…”