Postarthroscopic glenohumeral chondrolysis (PAGCL)

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Postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication of arthroscopic surgery in which there is rapid dissolution of articular cartilage with degenerative change of the glenohumeral articulation.

Epidemiology

PAGCL is more frequent in young people between 10 and 40 years, after arthroscopy ^1,2.

Clinical presentation

Patients present with shoulder pain and rapid decreased range of motion. Onset of symptoms is variable with a delay of up to 9 months postoperatively ^1,2.

Pathology

Pathophysiology of postarthroscopic glenohumeral chondrolysis is multifactorial. The process appears to be activated by chemical, mechanical and/or thermal factors that cause inflammation and degradation of the cartilage matrix, with apoptosis of chondrocytes ^1,2.

Risk factors for PAGCL are ^1,2:

1. placement of non-absorbable suture anchors and knots on the articular surface during surgery to correct instability (loose or prominent sutures/knots rub against the cartilage causing severe wear and tearing)

2. intra-articular pain pumps with exposure of the joint surface to irrigation solutions or high concentrations of local anesthetics (bupivacaine with epinephrine are highly associated with PAGCL ³)

3. thermal devices (radiofrequency to shrink the tissues)

4. family history of early arthritis and history of a collagen disorder

5. possible subclinical infections or a foreign body immune response from suture material

6. direct injury to the fragile cartilage with arthroscopic probes or other surgical instruments

Radiographic features

Plain radiograph

There is narrowing of the joint space, erosion of the bone surface, and loss of articular cartilage on both sides of the joint ^1,2.

MRI

• irregular and patchy areas of bone marrow edema ^1,2

Treatment and prognosis

• pharmacologic therapy

• shoulder arthroplasty