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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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Can you tell us what chondrolysis is? All we know is that our 21-year-old daughter has this after a previous ACL injury. It's putting an end to her basketball career.

Chondrolysis refers to the loss of articular cartilage, the smooth cartilage that allows the two joint surfaces to slide and glide against each other easily. Thinning of the cartilage narrows the joint space, putting more pressure on the joint and causing painful symptoms that eventually lead to joint arthritis. There are several different causes of this condition. Most of them have to do with complications after joint surgery. For example, chondrolysis has been known to develop when bone cement is used for joint replacements and it leaks into the joint or when gentian violet is used as a dye to test the integrity of the shoulder rotator cuff. The rotator cuff is made up of a group of four tendons and the attached muscles that surround the shoulder joint. The dye shows any tears or ruptures of the tendons of the rotator cuff. Radiofrequency (heat) energy used in some surgeries has also been linked with chondrolysis. But none of these causes is likely the reason for your daughter's problem. If she has had an anterior cruciate ligament (ACL) repair and now subsequent chondrolysis formation, she may be experiencing a long-term side effect of an intra-articular pain pump. The pain pump infuses the knee joint with a numbing agent called bupivacaine mixed with a pain reliever such as morphine. The purpose is to control post-operative pain and get the patient back up and moving as quickly as possible. Pain pumps have been in use after joint surgeries for many years now. But animal studies and human cadaver studies have shown that the bupivacaine kills 99 per cent of the chondrocytes (cartilage cells) that it comes in contact with. And a recent first-time report of three patients who had surgery to repair ACL injuries confirmed this association between chondrolysis and the use of a bupivacaine pain pump. This problem may occur more often than has been appreciated before because there is such a lag time between when the cartilage cells are exposed to the chemical and when symptoms first develop. Not only that, but the first symptoms of pain and swelling seem to precede any obvious damage by many months' time. There may be no known cause of the problem. For further information as it specifically relates to your daughter and what to do next, you will need to visit with her surgeon.


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