Cartilage Necrosis Due to Pin Penetration

Aprin, Hormozan; Goodman, Steven; Kahn, Leonard B.

doi:10.1097/01241398-199109000-00012

Cited by 10 publications

(4 citation statements)

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“…There is limited available literature suggesting a secondary, nonmechanical, immunogenic process that may further erode the hyaline cartilage when a mechanical process, such as pin protrusion, has occurred. 2,27 The metallic fragment was incorporated within the synovium of this patient and is not suspected to have contributed to chondrolysis in this patient or series.…”

Section: Discussionmentioning

confidence: 86%

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Postarthroscopic Glenohumeral Chondrolysis

Hansen¹,

et al. 2007

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Section: Discussionmentioning

confidence: 86%

“…The pain was both at rest and with motion (usually increased with motion). (2) Crepitus and decreasing active motion due to pain. Passive and active forward elevation and abduction were examined, as well as internal and external rotation at neutral and 90°of abduction (strength with these motions was also noted).…”

Section: Methodsmentioning

confidence: 99%

Postarthroscopic Glenohumeral Chondrolysis

Hansen¹,

et al. 2007

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“…19 The precise physiology of chondrolysis due to this mechanism has not been clearly defined, but it has been hypothesized that prolonged hardware penetration in the hip causes a mechanical irritation in conjunction with an immunologic process that subsequently erodes the hyaline cartilage. 1,19 Transient pin penetration alone (in which a penetrating pin is removed at the time of the initial surgery) has a much lower, if any, association with chondrolysis. 6,23,27 Also, chondrolysis can occur in untreated slipped capital femoral epiphysis (SCFE), pointing to the probability that the immunologic reaction is paramount in the process.…”

Section: Discussionmentioning

confidence: 99%

Glenohumeral Chondrolysis after Shoulder Arthroscopy

Petty¹,

et al. 2004

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Glenohumeral chondrolysis is a rare and devastating complication of shoulder arthroscopy. No case reports of glenohumeral chondrolysis after routine shoulder arthroscopy appear in the literature. Three cases of rapid glenohumeral joint destruction following shoulder arthroscopy are described. CASE 1A 16-year-old male baseball and football player complained of pain in his right, dominant shoulder after 3 episodes of subluxation over the course of 2 years secondary to diving on the football and baseball fields. He was treated conservatively after each but failed to improve with 4 months of rehabilitation after the third subluxation. He underwent right shoulder arthroscopy in April 2001 at an outside institution for debridement of a posteroinferior labral tear. Figure 1 shows a preoperative radiograph of the affected shoulder. A radiofrequency ablator was used for this debridement. An extensive synovectomy and a coracoacromial ligament resection were also performed with the ablator followed by a modified subacromial decompression. His postoperative course was complicated by poor return of glenohumeral motion and mild to moderate pain with activities of daily living (ADLs). He was unable to return to sports.His glenohumeral joint was injected 4 months after the procedure with steroid and marcaine. He reported good immediate relief of pain following the injection with relief lasting for only 24 hours. Plain radiography was repeated at 5 months postoperative (Figure 2). It demonstrated significant glenohumeral space narrowing with early subchondral cyst formation in the glenoid. He presented to our clinic for the first time the following week. Range of motion (ROM) at that time was forward elevation to 180°, external rotation with elbow at the side to 60°and internal rotation to L4, and 1+ anterior laxity. Physical therapy was continued, focusing on maintaining glenohumeral ROM.A rheumatologic evaluation was also recommended. It was subsequently normal. He returned again to our clinic 8 months after his shoulder arthroscopy. He described a slow progression of pain in his right shoulder since his last visit, now with substantial pain during ADLs. Plain radiographs demonstrated progression of the glenohumeral joint space narrowing (Figure 3). An MRI demonstrated thinning of the glenohumeral articular surfaces and subchondral cyst formation in the glenoid and humerus. A repeat arthroscopy was performed as a diagnostic maneuver to rule out infection and to obtain a synovial biopsy. Arthroscopic findings were as follows: the glenoid was devoid of articular cartilage, and the exposed subchondral bone appeared friable (Figure 4). The humeral head was covered with smooth hyaline cartilage, but marginal osteophytes were present. The synovium was red with numerous villous projections throughout. The labrum was degenerative circumferentially, also with villous fibrillations throughout ( Figure 5). Operative cultures were negative for aerobes, anaerobes, acid-fast bacilli, and fungus. Biopsy of the synovium demonstrated numerous v...

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“…Permanent pin penetration resulted in joint narrowing and widespread destruction. 22 Intraoperative radiography should be used to prevent pin penetration. 3 In situ fixation with a single, centrally located pin with an anterior starting point is likely to be the safest fixation method.…”

Section: Table 3 Comparison Of Southwick Headshaft Angles In Groups Amentioning

confidence: 99%

Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis

et al. 2007

J Orthop Surg (Hong Kong)

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Cartilage Necrosis Due to Pin Penetration

Cited by 10 publications

References 0 publications

Postarthroscopic Glenohumeral Chondrolysis

Postarthroscopic Glenohumeral Chondrolysis

Glenohumeral Chondrolysis after Shoulder Arthroscopy

Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis

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