A Retrospective Study Assessing Safety and Efficacy of Bipolar Radiofrequency Ablation for Knee Chondral Lesions

Gharaibeh, Monther; Szomor, Andras; Chen, Darren B.; MacDessi, Samuel J.

doi:10.1177/1947603517703731

Cited by 11 publications

(21 citation statements)

References 35 publications

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“…Tibial fixation was performed with the knee in full extension, with suspensory fixation via the GraftLink system (Arthrex) and a cortical tibial button. Meniscal injuries and cartilage damage were evaluated and calculated into the chondropenia severity score 11 (Appendix Table A1, available in the online version of this article).…”

Section: Methodsmentioning

confidence: 99%

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

et al. 2019

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Background: The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood. Purpose: To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed. Results: There was no significant difference in mean SNQ between male and female patients ( P > .05). Univariate regression analysis showed that a low femoral tunnel ( P = .005), lateral tibial tunnel ( P = .009), large femoral tunnel ( P = .011), large tibial tunnel ( P < .001), steep lateral PTS ( P = .010), steep medial PTS ( P = .004), acute graft sagittal angle ( P < .001), acute GBA ( P < .001), large graft volume ( P = .003), and high graft-notch volume ratio ( P < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio ( P = .001) and an acute GBA ( P = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score ( r = 0.227; P = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference. Conclusion: The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.

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Section: Methodsmentioning

confidence: 99%

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

et al. 2019

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“…Partial-thickness chondral defect has been found responsible for the degeneration of articular cartilage and remains without effective treatment methods [1,2]. In recent years, bipolar radiofrequency energy (bRFE) ablation has gained popularity among arthroscopic knee surgeries as a solution to articular cartilage lesions; it creates a smooth, stable cartilage surface by thermal shrinkage or removal of fibrillated cartilage and thus stops the progression of chondral degeneration [3].…”

Section: Introductionmentioning

confidence: 99%

The time-dependent effects of bipolar radiofrequency energy on bovine articular cartilage

Peng

Zhang

et al. 2020

J Orthop Surg Res

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Purpose: The purpose of this study was to compare the effect of bipolar radiofrequency energy (bRFE) on chondroplasty at the different time durations in an in vitro experiment that simulated an arthroscopic procedure. Methods: Six fresh bovine knees were used in our study. Six squares were marked on both the medical and lateral femoral condyles of each femur. Each square was respectively treated with bRFE for 0 s, 10 s, 20 s, 30 s, 40 s and 50 s. Full-thickness articular cartilage specimens were harvested from the treatment areas. Each specimen was divided into three distinct parts: one for hematoxylin/eosin staining histology, another for cartilage surface contouring assessment via scanning electron microscopy (SEM), and the last one for glycosaminoglycan (GAG) content measurement. Results: bRFE caused time-correlated damage to chondrocytes, and GAG content in the cartilage was negatively correlated to exposure time. bRFE caused time-correlated damage to chondrocytes. The GAG content in the cartilage negatively correlated with the exposure time. The sealing effect positively correlated with the exposure time. Additionally, it took at least 20 s of radiofrequency exposure to render a smooth cartilage surface and a score of 2 (normal) in the scoring system used. Conclusion: bRFE usage in chondroplasty could effectively trim and polish the cartilage lesion area; however, it induces a dose-dependent detrimental effect on chondrocytes and metabolic activity that negatively correlated with the treatment time. Therefore, cautions should be taken in the use of bRFE for treatment of articular cartilage injury.

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“…In this study, over 30% of the patients waiting for surgery after MRI evaluation of the affected knee were disqualified from surgical treatment due to benign MRI findings. Although arthroscopy is considered to be a safe surgical intervention with low incidence of adverse effects [12], one should not forget that it is a surgical procedure with potentially hazardous side effects.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

et al. 2019

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Purpose: This study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) in knee injuries. Methods: Ninety-six patients at a regional hospital were included in the study. Each participant underwent a physical examination in which menisci and ACL were evaluated. Knee joint MRI was collected from each patient. Physical examination and MRI scans were then compared with knee arthroscopy findings as a golden standard for meniscal and ligamentous lesions. The data were analyzed and specificity and sensitivity were calculated and correlated on receiver operating characteristics (ROC) curves. Results: Knee arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. The highest sensitivities were the McMurray test (87.5%) for medial meniscus (MM) and the Thessaly test (70%) for lateral meniscus (LM). The most sensitive ACL test was Lachman (84.5%), whereas, the pivot shift and Lelli tests were the most specific (98.5%). MRI was highly sensitive for MM (96%) with specificity of 52%. MRI showed lower sensitivity (70%) and higher specificity (85.5%) for LM. The specificity of MRI for ACL rupture was 92%, with sensitivity only 75%. Conclusion: McMurray and Apley tests for meniscal lesions seem the most appropriate in daily practice. A combination of lever signs, pivot shifts (PSs) and Lachman tests showed the best sensitivity and specificity in detecting ACL deficiency, and was superior to MRI.

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A Retrospective Study Assessing Safety and Efficacy of Bipolar Radiofrequency Ablation for Knee Chondral Lesions

Abstract: Bipolar radiofrequency ablation is a safe modality in treatment of chondral lesions.

Cited by 11 publications

References 35 publications

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

The time-dependent effects of bipolar radiofrequency energy on bovine articular cartilage

Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

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