Glenohumeral Thermal Capsulorrhaphy Is Not Recommended—Shoulder Chondrolysis Requires Additional Research

Abstract

In this issue, a report of 8 cases by Good, Shindle, Kelly, Wanich, and Warren1Good C.R. Shindle M.K. Kelly B.T. Wanich T. Warren R.F. Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy.Arthroscopy. 2007; 23: 797.e1-797.e5Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar confirms a concern voiced in previously published literature2Levine W.N. Clark Jr, A.M. D’Alessandro D.F. Yamaguchi K. Chondrolysis following arthroscopic thermal capsulorrhaphy to treat shoulder instability A report of two cases.J Bone Joint Surg Am. 2005; 87: 616-621Crossref PubMed Scopus (96) Google Scholar, 3Petty D.H. Jazrawi L.M. Estrada L.S. Andrews J.R. Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515Crossref PubMed Scopus (142) Google Scholar that the devastating complication of glenohumeral chondrolysis is associated with shoulder thermal capsulorrhaphy.Also reported in this issue, by Creighton, Romeo, Brown, Hayden, and Verma,4Creighton R.A. Romeo A.A. Brown F.M. Hayden J.K. Verma N.N. Revision arthroscopic shoulder instability repair.Arthroscopy. 2007; (In press)PubMed Google Scholar is that glenohumeral thermocapsular shrinkage had been performed in 9 of the 18 patients who later required a revision of their previous shoulder instability repair.Finally, as reported in this issue, capsular attenuation or ablation, yet another complication of shoulder thermal capsulorrhaphy,5Sperling J.W. Anderson K. McCarty E.C. Warren R.F. Complications of thermal capsulorrhaphy.Instr Course Lect. 2001; 50: 37-41PubMed Google Scholar is one of the few shoulder stabilization challenges that Kropf, Tjoumakaris, and Sekiya6Kropf E.J. Tjoumakaris F.P. Sekiya J.K. Arthroscopic shoulder stabilization: Is there ever a need to open?.Arthroscopy. 2007; 23: 779-784Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar believe may result in the possible need for open (as opposed to arthroscopic) shoulder stabilization.As the Editors of Arthroscopy, we cannot help but conclude that, pending evidence to the contrary, shoulder thermal capsulorrhaphy is a procedure in which these and other reported risks5Sperling J.W. Anderson K. McCarty E.C. Warren R.F. Complications of thermal capsulorrhaphy.Instr Course Lect. 2001; 50: 37-41PubMed Google Scholar outweigh any potential benefits.What is more, chondrolysis has also been reported to be caused by the use of gentian violet7Nakagawa Y. Ueo T. Miki T. Kotani H. Onishi E. Nakamura T. Glenohumeral osteoarthritis following a “color test” during rotator cuff repair A case report and a review of the literature.Bull Hosp Jt Dis. 1998; 57: 216-218PubMed Google Scholar, 8Shibata Y. Midorikawa K. Koga T. Honjo N. Naito M. Chondrolysis of the glenohumeral joint following a color test using gentian violet.Int Orthop. 2001; 25: 401-403Crossref PubMed Scopus (24) Google Scholar, 9Tamai K. Higashi A. Cho S. Yamaguchi T. Chondrolysis of the shoulder following a “color test”–assisted rotator cuff repair—A report of 2 cases.Acta Orthop Scand. 1997; 68: 401-402Crossref PubMed Scopus (37) Google Scholar and with intra-articular use of a pain pump.3Petty D.H. Jazrawi L.M. Estrada L.S. Andrews J.R. Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515Crossref PubMed Scopus (142) Google Scholar Additionally, in animal10Gomoll A.H. Kang R.W. Williams J.M. Bach B.R. Cole B.J. Chondrolysis after continuous intra-articular bupivacaine infusion: An experimental model investigating chondrotoxicity in the rabbit shoulder.Arthroscopy. 2006; 22: 813-819Abstract Full Text Full Text PDF PubMed Scopus (199) Google Scholar and in vitro11Chu C.R. Izzo N.J. Papas N.E. Fu F.H. In vitro exposure to 0.5% bupivicaine is cytotoxic to bovine articular chondrocytes.Arthroscopy. 2006; 22: 693-699Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar models, chondrolysis or chondrocyte cytotoxicity has been found to result from extreme levels of local anesthetic infusion. Idiopathic shoulder chondrolysis has also been described.12Kahan A. Amor B. Benhamou C.L. Rapidly progressive idiopathic chondrolysis simulating tuberculosis of the shoulder.J Rheumatol. 1983; 10: 291-293PubMed Google Scholar The etiology of glenohumeral chondrolysis may be multifactorial.3Petty D.H. Jazrawi L.M. Estrada L.S. Andrews J.R. Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515Crossref PubMed Scopus (142) Google ScholarFuture research is required to determine the cause, and proper prevention, of shoulder chondrolysis. In this issue, a report of 8 cases by Good, Shindle, Kelly, Wanich, and Warren1Good C.R. Shindle M.K. Kelly B.T. Wanich T. Warren R.F. Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy.Arthroscopy. 2007; 23: 797.e1-797.e5Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar confirms a concern voiced in previously published literature2Levine W.N. Clark Jr, A.M. D’Alessandro D.F. Yamaguchi K. Chondrolysis following arthroscopic thermal capsulorrhaphy to treat shoulder instability A report of two cases.J Bone Joint Surg Am. 2005; 87: 616-621Crossref PubMed Scopus (96) Google Scholar, 3Petty D.H. Jazrawi L.M. Estrada L.S. Andrews J.R. Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515Crossref PubMed Scopus (142) Google Scholar that the devastating complication of glenohumeral chondrolysis is associated with shoulder thermal capsulorrhaphy. Also reported in this issue, by Creighton, Romeo, Brown, Hayden, and Verma,4Creighton R.A. Romeo A.A. Brown F.M. Hayden J.K. Verma N.N. Revision arthroscopic shoulder instability repair.Arthroscopy. 2007; (In press)PubMed Google Scholar is that glenohumeral thermocapsular shrinkage had been performed in 9 of the 18 patients who later required a revision of their previous shoulder instability repair. Finally, as reported in this issue, capsular attenuation or ablation, yet another complication of shoulder thermal capsulorrhaphy,5Sperling J.W. Anderson K. McCarty E.C. Warren R.F. Complications of thermal capsulorrhaphy.Instr Course Lect. 2001; 50: 37-41PubMed Google Scholar is one of the few shoulder stabilization challenges that Kropf, Tjoumakaris, and Sekiya6Kropf E.J. Tjoumakaris F.P. Sekiya J.K. Arthroscopic shoulder stabilization: Is there ever a need to open?.Arthroscopy. 2007; 23: 779-784Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar believe may result in the possible need for open (as opposed to arthroscopic) shoulder stabilization. As the Editors of Arthroscopy, we cannot help but conclude that, pending evidence to the contrary, shoulder thermal capsulorrhaphy is a procedure in which these and other reported risks5Sperling J.W. Anderson K. McCarty E.C. Warren R.F. Complications of thermal capsulorrhaphy.Instr Course Lect. 2001; 50: 37-41PubMed Google Scholar outweigh any potential benefits. What is more, chondrolysis has also been reported to be caused by the use of gentian violet7Nakagawa Y. Ueo T. Miki T. Kotani H. Onishi E. Nakamura T. Glenohumeral osteoarthritis following a “color test” during rotator cuff repair A case report and a review of the literature.Bull Hosp Jt Dis. 1998; 57: 216-218PubMed Google Scholar, 8Shibata Y. Midorikawa K. Koga T. Honjo N. Naito M. Chondrolysis of the glenohumeral joint following a color test using gentian violet.Int Orthop. 2001; 25: 401-403Crossref PubMed Scopus (24) Google Scholar, 9Tamai K. Higashi A. Cho S. Yamaguchi T. Chondrolysis of the shoulder following a “color test”–assisted rotator cuff repair—A report of 2 cases.Acta Orthop Scand. 1997; 68: 401-402Crossref PubMed Scopus (37) Google Scholar and with intra-articular use of a pain pump.3Petty D.H. Jazrawi L.M. Estrada L.S. Andrews J.R. Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515Crossref PubMed Scopus (142) Google Scholar Additionally, in animal10Gomoll A.H. Kang R.W. Williams J.M. Bach B.R. Cole B.J. Chondrolysis after continuous intra-articular bupivacaine infusion: An experimental model investigating chondrotoxicity in the rabbit shoulder.Arthroscopy. 2006; 22: 813-819Abstract Full Text Full Text PDF PubMed Scopus (199) Google Scholar and in vitro11Chu C.R. Izzo N.J. Papas N.E. Fu F.H. In vitro exposure to 0.5% bupivicaine is cytotoxic to bovine articular chondrocytes.Arthroscopy. 2006; 22: 693-699Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar models, chondrolysis or chondrocyte cytotoxicity has been found to result from extreme levels of local anesthetic infusion. Idiopathic shoulder chondrolysis has also been described.12Kahan A. Amor B. Benhamou C.L. Rapidly progressive idiopathic chondrolysis simulating tuberculosis of the shoulder.J Rheumatol. 1983; 10: 291-293PubMed Google Scholar The etiology of glenohumeral chondrolysis may be multifactorial.3Petty D.H. Jazrawi L.M. Estrada L.S. Andrews J.R. Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.Am J Sports Med. 2004; 32: 509-515Crossref PubMed Scopus (142) Google Scholar Future research is required to determine the cause, and proper prevention, of shoulder chondrolysis.