title: Glenohumeral chondrolysis after arthroscopy: a systematic review of potential contributors and causal pathways.
abstract: OBJECTIVE
  This systematic review provides (1) a synthesis of existing clinical evidence that helps identify factors associated with the development of glenohumeral chondrolysis after arthroscopy (PAGCL), (2) a consolidated conceptualization of potential causal pathways that elucidate proposed mechanisms leading to PAGCL, and (3) a summary of implications for practice, policy, and future research.
  
  
  METHODS
  A computerized literature review using an iterative search process identified 245 publications in English between January 1960 and April 2009. After we applied inclusion and exclusion criteria, 35 articles were stratified into 4 categories of factors related to PAGCL: (1) patient factors, (2) surgical factors (preoperative and intraoperative), (3) postoperative factors, and (4) causal pathways.
  
  
  RESULTS
  The majority of studies (61%) focused on surgical factors correlated with PAGCL, and most were laboratory based (n = 21). Publications involving human subjects were descriptive case reports (n = 15), not epidemiologic studies. A total of 88 patients (91 shoulder surgeries) with PAGCL were identified in case reports. The majority of patients (55%) was male, and the mean age was 27.9 years (range, 13.1 to 64 years). Among patients, 68% (n = 53) had implants/anchors, 67% (n = 59) received local anesthetics through a pain pump, and 45% (n = 41) had surgeries involving radiofrequency devices. The causal pathways to PAGCL likely involve initiating and secondary cartilage injury due to mechanical, thermal, or chemical events. The result is a cascade of interactive cellular responses that may include inflammation and chondrocyte apoptosis causing disturbance of cellular metabolism with subsequent loss of the gliding surface, congruity, and synovial fluid, leading to increased friction and accelerated wear that ultimately yield PAGCL.
  
  
  CONCLUSIONS
  The literature is limited to correlates, rather than true risk factors, for PAGCL. Well-designed epidemiologic studies that examine various exposures in relation to health outcomes, while controlling for potential confounders, are needed to determine relative risks that allow causal inference, thereby facilitating sound practice and policy decision making.
  
  
  METHODS
  Level IV, systematic review.
authors.affiliation: Orthopaedic Sports Medicine and Shoulder Service, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Solomon
authors.forename: Maryam
authors.initials: M
authors.lastname: Navaie
authors.forename: Eric T
authors.initials: ET
authors.lastname: Stedje-Larsen
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Smith
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Provencher
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects*; D002357:Cartilage Diseases / Q000209:etiology*; D002358:Cartilage, Articular; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012785:Shoulder Joint / Q000601:surgery*; D055815:Young Adult