Articular cartilage and local anaesthetic: A systematic review of the current literature

Abhinav Gulihar; Shibby Robati; Haider Twaij; Alan Salih; Grahame J S Taylor

doi:10.1016/j.jor.2015.10.005

Articular cartilage and local anaesthetic: A systematic review of the current literature

J Orthop. 2015 Oct 31;12(Suppl 2):S200-10. doi: 10.1016/j.jor.2015.10.005. eCollection 2015 Dec.

Authors

Abhinav Gulihar¹, Shibby Robati², Haider Twaij³, Alan Salih², Grahame J S Taylor⁴

Affiliations

¹ Trauma and Orthopaedics, Dartford and Gravesham NHS Trust, UK.
² Trauma and Orthopaedics, East Sussex Hospitals, UK.
³ St. Mary's Hospital, London W2 1NY, UK.
⁴ Leicester General Hospital, Leicester LE5 4PW, UK.

Abstract

Background: Chondrolysis involves the breakdown of cartilage following arthroscopic surgery, most commonly affecting the glenohumeral joint.

Methods: This review summarises all clinical and laboratory studies regarding local anaesthetic (LA) and its association with chondrolysis. We identified 289 papers, 41 of which met our inclusion criteria and were included in the final review.

Results: Bupivacaine, lidocaine, ropivacaine and levobupivacaine are all toxic to cartilage. Intra-articular infusions confer a greater toxicity to cartilage than single injections.

Conclusions: Intra-articular LA pain pumps carry a high risk of chondrolysis and should be avoided. Further studies are indicated to assess long-term single exposure LA implications.

Keywords: Arthroscopy; Cartilage; Chondrolysis; GAG, glycosaminoglycan; IL-6, interleukin-6; LA, local anaesthetic; LDH, lactate dehydrogenase; Local anaesthetic; MgSO4, magnesium sulphate; PAGCL, post-arthroscopic glenohumeral chondrolysis; PBS, phosphate buffered saline; PG, proteoglycan; PP, pain pump; RCT, randomised controlled trial; Review; TKA, total knee athroplasty.