subject: Shoulder Surgery Pain Management And Rapid Chondrolysis [print this page] Many athletes have developed the condition known as chondrolysis after routine surgical procedures. This has puzzled many researchers, and led to a closer examination of the scientific literature. One interesting study is called, Chondrolysis after partial lateral meniscectomy in athletes by Pier Paolo Mariani, Raffaele Garofalo and Fabrizio Margheritini - Volume 16, Number 6 / June, 2008 - Knee Surgery, Sports Traumatology, Arthroscopy.
Here is an excerpt: Abstract - Rapid chondrolysis after partial arthroscopic lateral meniscectomy has been seldom reported in literature. Considering the relatively high number of partial lateral meniscectomy performed, we cannot understand why this complication is so rare. The purpose of this paper is to report a series of athletes developing a chondrolysis associated with posterolateral corner laxity after a partial lateral meniscectomy and attempt to hypothesize the pathogenesis of this devastating complication. Five male professional soccer players of Italian championship with a mean age of 26.8 years underwent a partial lateral meniscectomy because of a traumatic lateral meniscus tear. Patients showed a slight varus knee and there were clinical signs compatible with a meniscal tear.
No other pathological sign were found. An MRI scan confirmed these findings. After surgery patients were unable to resume sport activities because of swelling and knee pain during training sessions. At a mean time of 8 months (range 612 months) from surgery patients were re-examined and a new MRI scan was performed. Clinical examination revealed a slight swelling of the knee and signs of posterolateral corner laxity. MRI scan revealed intra-articular fluid and pathological findings of knee posterolateral corner associated with a thinning of the articular cartilage. Arthroscopy showed free cartilagineous debris floating into the knee and a high grade of cartilage damage on the lateral compartment. The evaluation of lateral compartment, ruled-out a new tear of the meniscal remnant and showed a positive drive-trough sign with knee in the Fig. 4 positioning.
All patients had an open re-tensioning of the posterior meniscofemoral capsule, and in one case, an augmentation of the popliteal tendon using a free semitendinous graft was also done. This surgery gave a complete resolution of symptoms and patients resumed sports activities without any restriction after a period between 4 and 5 months. Based on this experience we hypothesize that partial lateral meniscectomy may have a role in causing a subtle rotatory instability that combined with high stress of sports activity can dramatically increase the susceptibility of joint to chondrolysis, Varus knee seems to be a possible predisposing factor. Open surgery addressing the insufficiency of lateral or posterolateral corner has been found to be effective in improving knee function and resolve patients symptoms at a short-term follow-up.
Another interesting source is called, Complications in Knee and Shoulder Surgery
Management and Treatment Options for the Sports Medicine Orthopedist by Robert J. Meislin and Jeffrey Halbrecht - Pages 175-187. Here is an excerpt: As participation in overhead and collision athletics increases, so does the risk of shoulder instability. Many young and middle-age individuals are interested in activities that place their shoulders at risk. Since age is a factor, there is a limited window of opportunity to return to playing a sport. Sports medicine physicians need to apply the best possible techniques to allow the athlete to continue his or her participation while minimizing the risk of developing premature degenerative arthritis.1 The athletes expectations are high and many feel that most can be returned to full participation. The obstacle that stands in the way of a full recovery is recurrence of instability and avoiding complications. This chapter will address commonly seen complications that can limit successful surgical repair of an unstable shoulder. The complications included are recurrence of instability, shoulder stiffness, implant complications, articular destruction due to inflammation or chondrolysis, and degenerative arthritis.
The literature does not supply sufficient data on the incidence of these complications. Most of the peer review literature and textbook chapters refer to individual case reports and potential catastrophes. However, there is longitudinal data on patients with instability recurrence. Long-term studies show an increase in the number of patients who sustain recurrence of instability, which would have escaped a short-term study. Recurrence of instability with the most current techniques is in the single-digit incidence including arthroscopic and open reconstructive techniques.26 An operation that was successful in returning an athlete back to the offending sport is at risk for sustaining additional injuries.
If you found either of these excerpts interesting, please read the sources in their entirety. These researchers have done some outstanding work, and we all owe them a debt of gratitude.
