SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018
Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it, 111 citations in OpenAlex.
- A meta-analysis on the efficacy of the ropivacaine infiltration in comparison with other dental anesthetics.Clinical oral investigations · 2021Pooled it
- Efficacy of epinephrine in local infiltration analgesia on pain relief and opioid consumption following total knee arthroplasty: a randomized controlled trial.Acta orthopaedica · 2023Trial
- Molecular Mechanisms of Local Anesthetic Toxicity: From Ion Channel Dysregulation to Mitochondrial Dysfunction and Tissue-Specific Injury.International journal of molecular sciences · 2026Review
- In Vitro Cytotoxicity and Inflammatory Response of Local Anaesthetics and Corticosteroids in Canine Fibroblast-Like Synoviocytes.Cartilage · 2026Article
- Efficacy and Safety of Phrenic-Nerve Sparing Blocks vs. Interscalene Brachial Plexus Block for Shoulder Surgery.Current pain and headache reports · 2026Review
- Intracapsular injection of triple-drug solution in the treatment of early and mid-stage knee osteoarthritis.Frontiers in surgery · 2026Article
- Opioid Consumption Following Anterior Cruciate Ligament Reconstruction: A Systematic Review.Orthopaedic journal of sports medicine · 2025Review
- The Potency of Cytotoxic Mechanisms of Local Anesthetics in Human Chondrocyte Cells.International journal of molecular sciences · 2024Article
- Rapid Osteoarthritis and Femoral Head Collapse: A Case Series.Journal of orthopaedic case reports · 2024Article
- Article
- Efficacy of Intraoperative Intra-Articular Morphine on Post-Operative Pain and Opioid Consumption Following Hip Arthroscopy.The Iowa orthopaedic journal · 2024Article
- FactFinders for patient safety: Preventing local anesthetic-related complications: Local anesthetic chondrotoxicity and stellate ganglion blocks.Interventional pain medicine · 2023Article
- Tips and tricks in ultrasound-guided musculoskeletal interventional procedures.Journal of ultrasonography · 2023Article
- Does response to preoperative intra-articular anesthetic injections predict outcomes of femoroacetabular impingement syndrome?Archives of orthopaedic and trauma surgery · 2023Review
- Comparison of Analgesia Treatment Methods After Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of 42 Randomized Controlled Trials.Orthopaedic journal of sports medicine · 2023Review
- In vitro chondrotoxicity of bupivacaine, levobupivacaine and ropivacaine and their effects on caspase activity in cultured canine articular chondrocytes.The Journal of veterinary medical science · 2023Article
- The long head of biceps at the shoulder: a scoping review.BMC musculoskeletal disorders · 2023Article
- Can pre-operative intraarticular injection predict pain relief after total hip arthroplasty?BMC musculoskeletal disorders · 2023Article
- Cytotoxicity of Local Anesthetics on Bone, Joint, and Muscle Tissues: A Narrative Review of the Current Literature.Journal of pain research · 2023Review
- Effect of species, concentration and volume of local anesthetics on intervertebral disk degeneration in rats with discoblock.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMany studies have shown that local anesthetics may impede chondrocyte metabolism. However, the influence of a single-dose local anesthetics is controversial. The aim of this metaanalysis was to review the literature for studies investigating the cytotoxic effects of single-dose local anesthetics on chondrocytes and cartilage.
methodsA comprehensive literature search was performed using established search engines (Medline, Embase) to identify studies, investigating the influence of single-dose local anesthetics on cartilage. The systematic analysis included the influence on histology, cell viability, morphology, and matrix production depending upon dose, exposure time, and type of local anesthetics.
resultsTwelve studies with four different local anesthetics were included in this metaanalysis. Bupivacaine and lidocaine were found to be more chondrotoxic than mepivacaine and ropivacaine. The amount of dead cells increased in a substance-, dose-, and time-dependent process. Osteoarthritic cartilage seems to be more vulnerable compared to intact cartilage. The toxic effects occur first in the superficial cartilage layers and include damage to membrane integrity, mitochondrial DNA, and nuclear changes. There is no study that could show a significant chondrotoxic effect with low concentrations of bupivacaine (0.0625%), ropivacaine (0.1 and 0.2%), and mepivacaine (0.5%).
conclusionsThe cytotoxicity of local anesthetics on chondrocytes is dependent on dose, time, and type of local anesthetics. Single-dose intra-articular administration of local anesthetics impede chondrocyte metabolism and should be performed only with low concentrations for selected diagnostic purposes and painful joints. The use of lidocaine should be avoided. LEVEL OF EVIDENCE: II.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.