Our 22-year-old son went into arthroscopic surgery for a rotator cuff tear and came out 100 years older. Within weeks of the surgery, his shoulder had aged to the point of being like an old, old man with severe arthritis. The surgeon’s only explanation was to say “it happens sometimes.” Can you tell us anything more than that?

It is in fact true that a simple arthroscopic surgery of the shoulder for a rotator cuff tear or unstable shoulder joint can result in complete destruction of the joint. Within weeks to months, the entire surface of the shoulder joint (called the articular cartilage) is destroyed. Deep shoulder pain with rapid loss of motion (and then function) are the main symptoms of this problem.

Your son has a condition called postarthroscopic glenohumeral chondrolysis or PAGCL. Just as you describe, his shoulder has gone from age 22 to that of an older adult with osteoarthritis. And all he did was have arthroscopic surgery.

What went wrong and why did this happen? Studies show that the condition called chondrolysis develops when the chondrocytes (cartilage cells) suddenly stop working. They are no longer able to make new cartilage cells to replace the old or to maintain the healthy state of the joint cartilage.

The main risk factor is the arthroscopic surgery itself. But many people have arthroscopic shoulder surgery without developing chondrolysis afterwards. There must be other factors at play here. In fact, experts suggest there is likely a multifactorial etiology. In other words, several or even many risk factors combined together result in postarthroscopic glenohumeral chondrolysis (PAGCL).

A review of studies with reported cases of PAGCL shows a list of potential risk factors. These etiologic factors include direct trauma to the joint during surgery, shoulder instability before surgery, the use of bioabsorbable sutures and other implants, heating the joint with radiofrequency to shrink the tissues, and the placement of sutures (anchors and knots) on the joint (articular) surface.

Other possible risk factors being considered and investigated further include family history of early arthritis, patient history of a collagen disorder, and exposure of the joint surface to irrigation solutions or high concentrations of local anesthetics. There could also be some specific risk factor common to young patients that remains elusive (avoids detection).

Once the various risk factors and potential causes have been identified, the next step is prevention. When the destructive process begins, there is no going back. And without effective treatment, prevention is absolutely essential.

Postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication of shoulder arthroscopic surgery. But when it happens, the consequences can be devastating. And since the primary age group affected is young adults, every effort should be made to screen for risk factors and avoid anything that might contribute to this condition. Until more is known about the true etiology (cause) of PAGCL, surgeons follow current recommendations to prevent this problem but in the end, it’s true that “it happens” and we don’t always know why.