Severe chondrolysis after shoulder arthroscopy: a case series.
OBJECTIVE
Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications.


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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Bailie
David S
DS
The Orthopedic Clinic Association, PC, Scottsdale, AZ 85258, USA.
Ellenbecker
Todd S
TS
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D002045:Bupivacaine / Q000009:adverse effects; D002357:Cartilage Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002358:Cartilage, Articular / Q000187:drug effects / Q000503:physiopathology; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007270:Injections, Intra-Articular; D007593:Joint Instability / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D019534:Shoulder Impingement Syndrome / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D002045:Bupivacaine