PAGCL Cartilage Loss and Intra Articular Injections by Thor Anderson

Each day public awareness grows regarding the odds of developing PAGCL (cartilage damage) after a routine surgery. Although most of the commotion deals with procedures to the shoulder, knee surgery is not without its own risks. One interesting study that looks into the issue is called, Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee by D. Townshend, MBBS, FRCS(Orth), Specialist Registrar, Orthopaedics and Trauma1; K. Emmerson, MBBS, FRCS(Orth), Consultant Orthopaedic Surgeon; S. Jones, MBBch, FRCS(Orth), Consultant Orthopaedic Surgeon; P. Partington, MBBS, FRCS(Orth), Consultant Orthopaedic Surgeon; and S. Muller, MD, FRCS(Orth), Consultant Orthopaedic Surgeon - Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 5, 601-603. Here is an excerpt:

The administration of intra-articular local anaesthetic is common following arthroscopy of the knee. However, recent evidence has suggested that bupivacaine may be harmful to articular cartilage. This study aimed to establish whether infiltration of bupivacaine around the portals is as effective as intra-articular injection. We randomised 137 patients to receive either 20 ml 0.5% bupivacaine introduced into the joint (group 1) or 20 ml 0.5% bupivacaine infiltrated only around the portals (group 2) following arthroscopy. A visual analogue scale was administered one hour post-operatively to assess pain relief. Both patients and observers were blinded to the treatment group. A power calculation was performed.

The mean visual analogue score was 3.24 (SD 2.20) in group I and 3.04 (SD 2.31) in group 2. This difference was not statistically significant (p = 0.62).

Infiltration of bupivacaine around the portals had an equivalent effect on pain scores at one hour, and we would therefore recommend this technique to avoid the possible chondrotoxic effect of intra-articular bupivacaine.

Another interesting study that looks into failed instability repair is called, Failed shoulder stabilization surgery: what to do? by Ghodadra, Neil; Grumet, Robert; LeClere, Lance; Provencher, LCDR Matthew T MD, MC, USN - Current Orthopaedic Practice: August 2009 - Volume 20 - Issue 4 - p 365-373. Here is an excerpt: Abstract - Despite advances in arthroscopic techniques and implants for shoulder instability repair, the failure rate is still between 5-30%, resulting in a loss of functional performance of athletic and other shoulder activities. In general, failure of shoulder instability can be divided into failures from recurrence of instability, failure from postoperative stiffness, and failure from persistent pain. Each of these may occur individually or be part of a spectrum of issues surrounding the failed instability repair. Each cause should be carefully screened to elucidate the contributing factors. The treatment of a failed instability procedure is predicated upon a sound history and physical examination, with appropriate radiographic workup to exclude causes of failure such as rotator cuff tear, SLAP injury, and glenoid and humeral head bone loss. With careful attention to the factors associated with failed instability repair, a viable revision surgery plan can be devised to achieve optimal results.

If you found either of these excerpts interesting, please read the studies in their entirety. If you believe that you have developed PAGCL, or cartilage loss, you should consider getting a separate legal and medical opinion.

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