Postarthroscopic glenohumeral chondrolysis of the shoulder

Postarthroscopic glenohumeral chondrolysis is a devastating, poorly understood, and relatively rare complication. True chondrolysis involves the dissolution of articular cartilage, including the matrix and cellular elements, leading to premature and irreversible articular cartilage loss. Several factors have been implicated in this phenomenon; however, to date, no study has conclusively ascertained the causation. Potential causative agents include subclinical infection, high volume intra-articular infusion of certain anesthetics, arthroscopic implants, suture material, and thermal energy. One must also consider the possibility that chondrolysis represents an ongoing immunogenic process interrupted or possibly potentiated by surgical intervention. The complex homeostasis of articular cartilage is undoubtedly sensitive to agents introduced into the joint including mechanical, chemical, and temperature-dependent interventions. To date, several papers have described the phenomenon and the potential associations; however, there is no definitive answer although the use of high-dose bupivacaine as an intra-articular anesthetic seems to be contraindicated. The purpose of this article is to review the basic science regarding chondrolysis and to assess the current literature which focuses on postarthroscopic glenohumeral chondrolysis, as well as innovative treatment alternatives. It is unlikely that postoperative chondrolysis will be clearly understood until controlled studies are available, of which there are currently none.