Effects of Radiofrequency Energy on Human Articular Cartilage

Caffey, Sean; McPherson, Edward J.; Moore, Brian E.; Hedman, Thomas P.; Vangsness, C. Thomas

doi:10.1177/0363546504271965

Cited by 57 publications

(59 citation statements)

References 17 publications

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“…Radiofrequency-generating energy devices have been used clinically in musculoskeletal procedures, such as chondroplasty [9, 13, 35, 39, 41], arthroscopic treatment of intraarticular tissues [1, 3, 14, 21, 26, 29, 31, 33, 43], meniscectomy [16, 25], and treatment of musculoskeletal tumors [8, 12, 23, 24, 27, 34, 37], to provide hemostasis and thermal capsulorrhaphy.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency Energy on Cortical Bone and Soft Tissue: A Pilot Study

Menéndez

Ishihara

Weisbrode

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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BackgroundRadiofrequency-generating energy devices have been used clinically in musculoskeletal procedures to provide hemostasis and capsular shrinkage (thermal capsulorrhaphy). However, the dose-effects are not well known.Questions/PurposesWe therefore determined dosage effects of radiofrequency energy on bone, skin incisions, and joint capsule in sheep.MethodsFive mature sheep had six 2.5-cm2 tibial periosteal defects and six 1.0-cm skin incisions assigned to six treatments varying by watts and fluence (f = watts · seconds/cm2): (1) untreated control, (2) 50 W for 9.5 seconds (190f; n = 5), (3) 110 W for 4.3 seconds (190f; n = 5), (4) 170 W for 2.8 seconds (190f; n = 5), (5) 170 W for 5.6 seconds (380f; n = 5), or (6) 170 W for 8.4 seconds (570f; n = 5). Outcomes included hemostasis, contraction, healing, and histomorphometry for inflammation and necrosis at 2 weeks.ResultsRadiofrequency energy application on skin at 190f or greater had more than 80% hemostasis and dose-dependent contraction, inflammation, and necrosis. Radiofrequency energy application on bone had good (70%) hemostasis at 190f and complete (> 95%) hemostasis at 380f and 570f, without histologic or clinically detectable necrosis.ConclusionsHemostasis can be achieved with radiofrequency energy at 190f in skin and bone. Bone necrosis was not detected at up to 570f. Using fluence greater than 190f in skin achieved dose-dependent necrosis and incisional contraction.Clinical RelevanceRadiofrequency energy can be used on bone and skin for hemostasis, but potential incisional complications, such as necrosis and an atypical firm and desiccated surface, should be expected.

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Section: Introductionmentioning

confidence: 99%

Radiofrequency Energy on Cortical Bone and Soft Tissue: A Pilot Study

Menéndez

Ishihara

Weisbrode

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The primary issue is the viability and denaturation of the remaining articular cartilage after thermal treatment. 7,[11][12][13][14][15][16] Recently, there has been increased focus on the various techniques used to evaluate the cartilage after treatment. [17][18][19] This has included histological techniques such as hematoxylin and eosin staining and confocal laser microscopy.…”

Section: Introductionmentioning

confidence: 99%

Development of partial thickness articular cartilage injury in an ovine model

Markel

Swain

et al. 2006

Journal Orthopaedic Research

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The purpose of this study was to create a controlled partial thickness cartilage lesion in a sheep model, and to provide a foundation to study the natural history of the progression of this lesion. Twenty-eight sheep divided into four groups (1, 12, 24, and 52 weeks, n ¼ 7/group) were used in this study. In one stifle, a mechanical tool was used to create a 200 mm partial thickness lesion (1.5 Â 1.5 cm 2 ) on the medial femoral condyle via arthroscopy. Joint fluid was drawn presurgery and after euthanasia for analysis of collage II 3/4 C long (C2C). After euthanasia, the condyle was analyzed by gross appearance, confocal laser microscopy (CLM) for cell viability, scanning electronic microscopy (SEM) for surface roughness, Artscan for cartilage stiffness, and histology for cartilage morphology. The gross appearance of the treated area appeared rough, soft, and swollen compared to untreated control over time. CLM demonstrated that the depth of cell death increased to 590 mm at 52 weeks after surgery. SEM demonstrated that the treated area became more irregular over time. Stiffness of the treated area was significantly less than control by 12 weeks after surgery. Histologic analysis demonstrated that the 12, 24, and 52 week groups had significantly poorer histologic scores than the 1 week group. Joint fluid analysis demonstrated that the treatment group at 1 week had significant higher levels of C2C than the pretreatment baseline data. The results of this study demonstrated that partial thickness injury of cartilage continued to propagate and degenerate over time in this sheep model. Options for the prevention or treatment of this lesion may be tested using this model in the future. ß

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“…The results are highly inconsistent, from minimal damage to massive cellular death to the extent that all cartilage layers were involved. 4,13,15 Still, there is no consensus on RFE's safety and efficacy. Also, it has yet to be figured out how other important factors such as mechanical properties of the cartilage are affected.…”

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confidence: 99%