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

      In this issue, a report of 8 cases by Good, Shindle, Kelly, Wanich, and Warren
      • Good C.R.
      • Shindle M.K.
      • Kelly B.T.
      • Wanich T.
      • Warren R.F.
      Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy.
      confirms a concern voiced in previously published literature
      • Levine 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.
      • Petty D.H.
      • Jazrawi L.M.
      • Estrada L.S.
      • Andrews J.R.
      Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.
      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,
      • Creighton R.A.
      • Romeo A.A.
      • Brown F.M.
      • Hayden J.K.
      • Verma N.N.
      Revision arthroscopic shoulder instability repair.
      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,
      • Sperling J.W.
      • Anderson K.
      • McCarty E.C.
      • Warren R.F.
      Complications of thermal capsulorrhaphy.
      is one of the few shoulder stabilization challenges that Kropf, Tjoumakaris, and Sekiya
      • Kropf E.J.
      • Tjoumakaris F.P.
      • Sekiya J.K.
      Arthroscopic shoulder stabilization: Is there ever a need to open?.
      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 risks
      • Sperling J.W.
      • Anderson K.
      • McCarty E.C.
      • Warren R.F.
      Complications of thermal capsulorrhaphy.
      outweigh any potential benefits.
      What is more, chondrolysis has also been reported to be caused by the use of gentian violet
      • Nakagawa 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.
      • Shibata Y.
      • Midorikawa K.
      • Koga T.
      • Honjo N.
      • Naito M.
      Chondrolysis of the glenohumeral joint following a color test using gentian violet.
      • Tamai K.
      • Higashi A.
      • Cho S.
      • Yamaguchi T.
      Chondrolysis of the shoulder following a “color test”–assisted rotator cuff repair—A report of 2 cases.
      and with intra-articular use of a pain pump.
      • Petty D.H.
      • Jazrawi L.M.
      • Estrada L.S.
      • Andrews J.R.
      Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.
      Additionally, in animal
      • Gomoll 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.
      and in vitro
      • Chu C.R.
      • Izzo N.J.
      • Papas N.E.
      • Fu F.H.
      In vitro exposure to 0.5% bupivicaine is cytotoxic to bovine articular chondrocytes.
      models, chondrolysis or chondrocyte cytotoxicity has been found to result from extreme levels of local anesthetic infusion. Idiopathic shoulder chondrolysis has also been described.
      • Kahan A.
      • Amor B.
      • Benhamou C.L.
      Rapidly progressive idiopathic chondrolysis simulating tuberculosis of the shoulder.
      The etiology of glenohumeral chondrolysis may be multifactorial.
      • Petty D.H.
      • Jazrawi L.M.
      • Estrada L.S.
      • Andrews J.R.
      Glenohumeral chondrolysis after shoulder arthroscopy: Case reports and review of the literature.
      Future research is required to determine the cause, and proper prevention, of shoulder chondrolysis.

      References

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        Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy.
        Arthroscopy. 2007; 23: 797.e1-797.e5
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        Chondrolysis following arthroscopic thermal capsulorrhaphy to treat shoulder instability.
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