Shoulder Chondrolysis

Complication of Arthroscopic Shoulder Surgery

slap repair
A SLAP repair is a type of shoulder arthroscopy. Alvis Upitis / Getty Images

Arthroscopic surgery is a procedure that is performed on the body's joints, including the shoulders. A surgeon places a video camera inside a joint, along with specialized instruments, to perform surgery through small incisions. Arthroscopic surgery often leads to a faster recovery when compared to traditional "open surgery" because less soft-tissue damage occurs as a result of the minimally invasive techniques.

The surgery is considered very safe, and serious complications are rare. However, as is the case with any operation, there are possible complications. Some of these can have devastating effects. Once such complication of shoulder arthroscopy is called chondrolysis.

What Is Chondrolysis?

Chondrolysis is a condition that causes the rapid disintegration of cartilage within a joint. A joint is where two bones connect. In a normal joint, the ends of bone are covered with a slippery, smooth, cushioning layer of tissue called "cartilage." The cartilage consists of cells called chondrocytes, surrounded by a scaffold of protein and water called "matrix."

In patients with chondrolysis, the chondrocytes die and the matrix scaffold falls apart. Once the cartilage is gone, it will not come back or heal. When the cartilage layer is lost, the rough bone underneath is exposed.

The appearance of chondrolysis is similar to osteoarthritis of the shoulder.

However, osteoarthritis is a condition that typically affects the elderly and develops over decades. Shoulder chondrolysis typically develops very quickly, sometimes over weeks or months. It usually occurs in younger patients and is most often associated with recent arthroscopic surgery. The average age of a patient who experiences chondrolysis after shoulder arthroscopy is 26.

Causes of Chondrolysis

Understanding the cause of chondrolysis after shoulder arthroscopy has been a challenge. Over the last two decades, doctors have periodically proclaimed the cause of this complication, only to find that there may or may not have been the associations that were suspected. Some of those causes include:

  • Heat probes: Thermal heat probes were used commonly in the early days of shoulder arthroscopy. Heat probes use a radiofrequency device to deliver heat directly to soft-tissues. Heat probes can be used to cauterize a blood vessel or shrink soft-tissue. They have been implicated in cartilage injury. Heat probes once were used to shrink the shoulder joint lining in patients with shoulder instability to tighten up the joint. This procedure, called "thermal shrinkage," is no longer performed.
  • Poor surgical technique: Several surgical errors can cause cartilage damage, including injuring the cartilage with arthroscopic instruments, leaving implants prominent or putting pressure on cartilage with suture materials.
  • Pain pumps: Pain pumps deliver high concentrations of local anesthetic directly into a joint. The pumps were left in place after surgery to help control pain, but some speculate the high concentration of anesthetic may lead to chondrolysis.

It is not known if one or all of these may be the cause of shoulder chondrolysis. Most surgeons have moved away from pain pumps and heat probes to ensure that their patients are as safe as possible.

Chondrolysis Treatment

Unfortunately, by the time chondrolysis has been diagnosed, the condition has typically progressed to a serious level. There is no known way to stop the progression of chondrolysis, and there is no known way to reverse its effects.  It is possible that at some point in the future, there will be some medication or injection that can be used to "shut off" the cellular problem that causes cartilage deterioration.  However, at this point, that is not the case.

The only treatment is pain control and changing activities. Most patients have discomfort and will lose mobility of the shoulder joint. Some patients will opt to have shoulder replacement; however, given that chondrolysis commonly occurs during a patient's teens or twenties, this may not be a reasonable treatment option. Shoulder replacements are designed for older patients, and ideally will last a few decades. For a young patient, this may mean having a shoulder replacement wear out, perhaps more than once. Repeat shoulder replacements are harder to perform, and may not achieve as good results.


Yeh PC & Kharrazi FD. "Postarthroscopic Glenohumeral Chondrolysis" J Am Acad Orthop Surg February 2012 ; 20:102-112.; doi:10.5435/JAAOS-20-02-102

Continue Reading