Chondrotoxic Effects of Local Anesthetics on Human Knee Articular Cartilage: A Systematic Review

PM R. 2019 Apr;11(4):379-400. doi: 10.1002/pmrj.12007. Epub 2019 Mar 15.


Objective: To review the current literature on the effects of intraarticular local anesthetics on human knee articular cartilage.

Literature survey: PubMed; MEDLINE; SCOPUS; PEDro; CINAHL databases (1/1990-06/1/2018) were searched for local anesthetic effects on human knee articular cartilage.

Methodology: Sixteen studies met the inclusion criteria, with outcome measures assessing chondrocyte viability, morphology, and histology. A systematic review was performed using PRISMA guidelines.

Synthesis: 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 0.75%. 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.

Conclusions: 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 coadministration of corticosteroids. Ropivacaine at concentrations of 0.5% or less was found to be the least chondrotoxic anesthetic.

Level of evidence: I.

Publication types

  • Systematic Review

MeSH terms

  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / adverse effects*
  • Bupivacaine / administration & dosage
  • Bupivacaine / adverse effects
  • Cartilage, Articular / cytology*
  • Cell Survival / drug effects
  • Chondrocytes / drug effects*
  • Humans
  • Injections, Intra-Articular
  • Knee Joint*
  • Lidocaine / administration & dosage
  • Lidocaine / adverse effects
  • Ropivacaine / administration & dosage
  • Ropivacaine / adverse effects


  • Anesthetics, Local
  • Ropivacaine
  • Lidocaine
  • Bupivacaine