J Korean Orthop Assoc.  2011 Feb;46(1):88-94. 10.4055/jkoa.2011.46.1.88.

Rapid Chondrolysis of Knee Joint after Arthroscopy Using Radiofrequency Device

• Lee CH
• Ha CW

• KMID: 2106578
• DOI: http://doi.org/10.4055/jkoa.2011.46.1.88

Abstract

We report the cases of 3 young individuals, each of whom presented to our hospital for the evaluation and treatment of sudden onset chondrolysis. Previously, all 3 individuals had undergone arthroscopic knee procedures over a similar time at another hospital. In this paper, we review the possible problems that cause chondrolysis during or after arthroscopic procedures, such as the followings: use of thermal treatment, occult infection with Propionibacterium acnes, idiopathic or iatrogenic osteochondral injury, high temperature of fluid during arthroscopic irrigation, improperly placed implants, and the use of an intra-articular pain pump. We can exclude other causes of chondrolysis through the clinical course of the patients and surgical records and progress records. We conclude that the possible cause of chondrolysis in all cases was due to thermal injury caused by high temperatures, which decreased or blocked the irrigation fluid flow generated during arthroscopy.

Keyword

chondrolysis; knee; thermal injury; irrigation fluid

MeSH Terms

Arthroscopy
Humans
Knee
Knee Joint
Propionibacterium acnes

Figure

• 

  Figure 1 MR images of a 15-year-old female before arthroscopic procedure show an articular cartilage injury of the lateral femoral condyle without any other conditions in the left knee (A-D). MR images 11 months after arthroscopic procedure show tricompartmental chondrolysis, large subchondral cyst of the lateral femoral condyle and subluxation of the medial meniscus (E-H).

• 

  Figure 2 Arthroscopic views from the anteromedial portal show an articular cartilage lesion (Outerbridge grade II) (A, B) and thermal trimming by radiofrequency instrument (Arthrocare, Austin, TX, USA) (C, D).

• 

  Figure 3 MR images of a 37-year-old female before arthroscopic procedure show an swelling and partial tear of the anterior cruciate ligament and lateral meniscal injury in the left knee (A-D). MR images 11 months after arthroscopic procedure show tricompartmental chondrolysis, subtotal meniscectomy state of the medial meniscus and focal chondral defect of trochlea groove (E-H).

• 

  Figure 4 MR images of a 29-year-old female before arthroscopic procedure show a medial pathologic plica without any other conditions in the left knee (A-D). MR images 11 months after arthroscopic procedure show tricompartmental chondrolysis, focal chondral defect of medial tibial condyle and trochlea groove and complex tear of medial meniscus posterior horn (E-H).

Reference

1. Petty DH, Jazrawi LM, Estrada LS, Andrews JR. Glenohumeral chondrolysis after shoulder arthroscopy: case reports and review of the literature. Am J Sports Med. 2004. 32:509–515.

2. Levine WN, Clark AM Jr, D'Alessandro DF, Yamaguchi K. Chondrolysis following arthroscopic thermal capsulorrhaphy to treat shoulder instability. A report of two cases. J Bone Joint Surg Am. 2005. 87:616–621.

3. Hansen BP, Beck CL, Beck EP, Townsley RW. Postarthroscopic glenohumeral chondrolysis. Am J Sports Med. 2007. 35:1628–1634.

4. Good CR, Shindle MK, Kelly BT, Wanich T, Warren RF. Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy. 2007. 23:797.e1–797.e5.

5. Levy PY, Fenollar F, Stein A, et al. Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis. 2008. 46:1884–1886.

6. Lu Y, Edwards RB 3rd, Nho S, Cole BJ, Markel MD. Lavage solution temperature influences depth of chondrocyte death and surface contouring during thermal chondroplasty with temperature-controlled monopolar radiofrequency energy. Am J Sports Med. 2002. 30:667–673.

7. Slabaugh MA, Friel NA, Cole BJ. Rapid chondrolysis of the knee after anterior cruciate ligament reconstruction: a case report. J Bone Joint Surg Am. 2010. 92:186–189.

8. Fester EW, Noyes FR. Postoperative chondrolysis of the knee: 3 case reports and a review of the literature. Am J Sports Med. 2009. 37:1848–1854.

9. Turner AS, Tippett JW, Powers BE, Dewell RD, Mallinckrodt CH. Radiofrequency (electrosurgical) ablation of articular cartilage: a study in sheep. Arthroscopy. 1998. 14:585–591.

10. Zoric BB, Horn N, Braun S, Millett PJ. Factors influencing intra-articular fluid temperature profiles with radiofrequency ablation. J Bone Joint Surg Am. 2009. 91:2448–2454.