Postarthroscopic Glenohumeral Chondrolysis

• Published in: The American journal of sports medicine 2007-10, Vol.35 (10), p.1628-1634
• Main Authors: Hansen, Brent P., Beck, Charles L., Beck, Elizabeth P., Townsley, Robert W.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Arthroscopy; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Care and treatment; Cartilage, Articular - drug effects; Chondrocytes - drug effects; Drug infusion pumps; Endoscopy; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Hormones; Humans; Injections, Intra-Articular; Investigative techniques, diagnostic techniques (general aspects); Joint Diseases - chemically induced; Joint Diseases - surgery; Male; Medical equipment; Medical sciences; Middle Aged; Pain; Pain - drug therapy; Pain - etiology; Postoperative Period; Retrospective Studies; Shoulder; Shoulder Joint - drug effects; Shoulder Joint - surgery; Shoulder pain; Sport (general aspects); Sports injuries; Sports medicine; Traumas. Diseases due to physical agents; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546507304136

Background: Recent reports have noted the appearance of postarthroscopic glenohumeral chondrolysis. Although this devastating process has been identified, no cause has been directly identified. Hypothesis: A cause of postarthroscopic glenohumeral chondrolysis will be associated with a specific factor (ie, implanted device, surgical technique, etc), and this factor can be identified by a review and comparison of cases seen in the senior author’s office. Study Design: Case series; Level of evidence, 4. Methods: Analyze possible etiologic factors with imaging studies, demographics, history, and physical examinations of 10 patients (12 shoulders) with postarthroscopic glenohumeral chondrolysis, and then compare perisurgical information with a focused chart review and comparison with the rest of the 177 arthroscopic shoulder surgeries in the same period of time. Results: There were 12 cases of postarthroscopic glenohumeral chondrolysis (all were the senior author’s patients). Four common factors were identified, and only high-flow intra-articular pain pump catheters filled with bupivacaine and epinephrine were a new addition to years of shoulder surgery by the senior author; 177 shoulders underwent arthroscopy in the identified time frame, and only 19 shoulders, of 30 with capsular procedures, had intra-articular pain pump catheters filled with bupivacaine and epinephrine. Of these, 12 have been identified with chondrolysis. Conclusion: Use of intra-articular pain pump catheters eluting bupivacaine with epinephrine appear highly associated with postarthroscopic glenohumeral chondrolysis. Clinical Relevance: Intra-articular pain pump catheters, especially those eluting bupivacaine with epinephrine, should be avoided until further investigation. Keywords: chondrolysis arthroscopy shoulder pain pump bupivacaine epinephrine