BACKGROUND: Injectable local anesthetics (LA) have been used consistently in clinical practice for intra-articular (IA) pathology.PURPOSE: To review the current literature on the effects of IA local anesthetics on human knee articular cartilage.STUDY DESIGN: Systematic Review METHODS: A PubMed; MEDLINE; SCOPUS; PEDro; CINAHL databases (1/1990-06/1/2018) were searched for local anesthetic effects on human knee articular cartilage with outcome measures assessing chondrocyte viability, morphology and histology. Sixteen studies met inclusion criteria.RESULTS: 16 studies were found meeting inclusion/exclusion criteria. Seven studies were identified evaluating lidocaine, with five of them demonstrating statistically significant chondrotoxic effects. Fourteen studies examined bupivacaine, with all but one study demonstrating a chondrotoxic effect. Eight studies examined ropivacaine and found a dose dependent chondrotoxicity starting at .75%. Two studies evaluated levobupivacaine showing chondrotoxicity, with one study showing it to be more chondrotoxic than bupivacaine. One study looked at mepivacaine, and showed it to have more chondrotoxicity than ropivacaine. When studied the chondrotoxicity was found to be both dose and time dependent. Also, the addition of corticosteroids appeared to worsen the chondrotoxic effects.CONCLUSION: Lidocaine, bupivacaine, ropivacaine, levobupivacaine, and mepivacaine were reported to have dose and time dependent deleterious effects on chondrocytes that appeared to be made worse by the co-administration of corticosteroids. Ropivacaine at concentrations of .5% and less was found to be the least chondrotoxic anesthetic.
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