title: Articular cartilage and local anaesthetic: A systematic review of the current literature.
abstract: BACKGROUND
  Chondrolysis involves the breakdown of cartilage following arthroscopic surgery, most commonly affecting the glenohumeral joint.
  
  
  METHODS
  This review summarises all clinical and laboratory studies regarding local anaesthetic (LA) and its association with chondrolysis. We identified 289 papers, 41 of which met our inclusion criteria and were included in the final review.
  
  
  RESULTS
  Bupivacaine, lidocaine, ropivacaine and levobupivacaine are all toxic to cartilage. Intra-articular infusions confer a greater toxicity to cartilage than single injections.
  
  
  CONCLUSIONS
  Intra-articular LA pain pumps carry a high risk of chondrolysis and should be avoided. Further studies are indicated to assess long-term single exposure LA implications.
authors.affiliation: Trauma and Orthopaedics, Dartford and Gravesham NHS Trust, UK.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Gulihar
authors.affiliation: Trauma and Orthopaedics, East Sussex Hospitals, UK.
authors.forename: Shibby
authors.initials: S
authors.lastname: Robati
authors.affiliation: St. Mary's Hospital, London W2 1NY, UK.
authors.forename: Haider
authors.initials: H
authors.lastname: Twaij
authors.affiliation: Trauma and Orthopaedics, East Sussex Hospitals, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Salih
authors.affiliation: Leicester General Hospital, Leicester LE5 4PW, UK.
authors.forename: Grahame J S
authors.initials: GJ
authors.lastname: Taylor
keywords: Arthroscopy; Cartilage; Chondrolysis; GAG, glycosaminoglycan; IL-6, interleukin-6; LA, local anaesthetic; LDH, lactate dehydrogenase; Local anaesthetic; MgSO4, magnesium sulphate; PAGCL, post-arthroscopic glenohumeral chondrolysis; PBS, phosphate buffered saline; PG, proteoglycan; PP, pain pump; RCT, randomised controlled trial; Review; TKA, total knee athroplasty