Postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication of

arthroscopic surgery Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the jo ...

and involves

chondrolysis Chondrolysis CD Code is the process of breakdown of cartilage. It can occur as a result of trauma (traumatic chondrolysis). Intra-articular infusions of certain local anesthetic agents such as bupivacaine, lidocaine, ropivacaine and levobupivacai ...

wherein the articular

cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck an ...

of the

shoulder The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder mak ...

undergoes rapid, degenerative changes shortly after arthroscopic surgery.

Causes

Bupivacaine Bupivacaine, marketed under the brand name Marcaine among others, is a medication used to decrease feeling in a specific area. In nerve blocks, it is injected around a nerve that supplies the area, or into the spinal canal's epidural space. It ...

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

ropivacaine Ropivacaine (rINN) is a local anaesthetic drug belonging to the amino amide group. The name ropivacaine refers to both the racemate and the marketed ''S''-enantiomer. Ropivacaine hydrochloride is commonly marketed by AstraZeneca under the brand na ...

and

levobupivacaine Levobupivacaine (International Nonproprietary Name, rINN) is a local anaesthetic drug belonging to the amino amide group. It is the ''S''-enantiomer of bupivacaine. Levobupivacaine hydrochloride is commonly marketed by AbbVie under the trade nam ...

are all toxic to cartilage and their intra-articular infusions can lead to this toxic effect. Intra-articular pain pumps with local anesthetics have been implicated as a potential cause.

Diagnosis

Treatment

Total Joint Arthroplasty or reverse total joint arthroplasty (shoulder replacement surgery)

References

Orthopedic surgical procedures Local anesthetics Chondropathies Rare diseases Rheumatology {{musculoskeletal-disease-stub