Ex Vivo Comparison of Mechanical Versus Thermal Chondroplasty: Assessment of Tissue Effect at the Surgical Endpoint

Lotto, Marie L.; Wright, Emma J.; Appleby, David; Zelicof, Steven B.; Lemos, Mark J.; Lubowitz, James H.

doi:10.1016/j.arthro.2007.09.018

Cited by 33 publications

(34 citation statements)

References 21 publications

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“…The treatment replaced the fibrillated cartilage with a significant region of tissue loss and a resultant bed of necrotic cartilage. These results confirm other studies showing significant iatrogenic damage and loss of cartilage with monopolar ablation systems [10-12, 15, 16, 18, 19, 21, 30, 31]. Despite this evidence, some have put forth the notion that the iatrogenic creation of charred, necrotic articular cartilage tissue is useful to protect the underlying undamaged cartilage from excess energy deposition which normally occurs during the treatment [41].…”

Section: Discussionsupporting

confidence: 86%

Histopomorphic Evaluation of Radiofrequency Mediated Débridement Chondroplasty

Ganguly¹,

McRury²,

Goodwin³

et al. 2010

TOORTHJ

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The use of radiofrequency devices has become widespread for surgical ablation procedures. When ablation devices have been deployed in treatment settings requiring tissue preservation like débridement chondroplasty, adoption has been limited due to the collateral damage caused by these devices in healthy tissue surrounding the treatment site. Ex vivo radiofrequency mediated débridement chondroplasty was performed on osteochondral specimens demonstrating surface fibrillation obtained from patients undergoing knee total joint replacement. Three radiofrequency systems designed to perform débridement chondroplasty were tested each demonstrating different energy delivery methods: monopolar ablation, bipolar ablation, and non-ablation energy. Treatment outcomes were compared with control specimens as to clinical endpoint and histopomorphic characteristics. Fibrillated cartilage was removed in all specimens; however, the residual tissue remaining at the treatment site displayed significantly different characteristics attributable to radiofrequency energy delivery method. Systems that delivered ablation-based energies caused tissue necrosis and collateral damage at the treatment site including corruption of cartilage Superficial and Transitional Zones; whereas, the non-ablation system created a smooth articular surface with Superficial Zone maintenance and without chondrocyte death or tissue necrosis. The mechanism of radiofrequency energy deposition upon tissues is particularly important in treatment settings requiring tissue preservation. Ablation-based device systems can cause a worsened state of articular cartilage from that of pre-treatment. Non-ablation energy can be successful in modifying/preconditioning tissue during débridement chondroplasty without causing collateral damage. Utilizing a non-ablation radiofrequency system provides the ability to perform successful débridement chondroplasty without causing additional articular cartilage tissue damage and may allow for other cartilage intervention success.

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Section: Discussionsupporting

confidence: 86%

Histopomorphic Evaluation of Radiofrequency Mediated Débridement Chondroplasty

Ganguly¹,

McRury²,

Goodwin³

et al. 2010

TOORTHJ

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“…Osteonecrosis averaged a maximum depth of 126 μm after 4 s and 942 μm after 8 s of exposure. Though recent clinical studies found no incidents of avascular necrosis 6 or 12 months after RFE treatment and, when compared to mechanical shaving, thermal chondroplasty resulted in greater smoothing of chondromalacic cartilage with decreased total tissue effects, it remains to be proven whether focal osteonecrotic lesions occur more frequently under clinical conditions than previously expected, becoming symptomatic in only in a small number of patients due to a stepwise regeneration [7, 26, 27]. …”

Section: Discussionmentioning

confidence: 99%

Impact of monopolar radiofrequency energy on subchondral bone viability

Balcarek

Kuhn

Weigel

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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The purpose of this study was to analyze the impact of monopolar radiofrequency energy treatment on subchondral bone viability. The femoral grooves of six chinchilla bastard rabbits were exposed bilaterally to monopolar radiofrequency energy for 2, 4 and 8 s, creating a total of 36 defects. An intravital fluorescence bone-labeling technique characterized the process of subchondral bone mineralization within the 3 months following exposure to radiofrequency energy and was analyzed by widefield epifluorescence optical sectioning microscopy using an ApoTome. After 2 s of radiofrequency energy exposure, regular fluorescence staining of the subchondral bone was evident in all samples when compared to untreated areas. The depth of osteonecrosis after 4 and 8 s of radiofrequency energy treatment averaged 126 and 942 µm at 22 days (P < .05; P < .01). The 4 s treatment group showed no osteonecrosis after 44 days whereas the depth of osteonecrosis extended from 519 µm at 44 days (P < .01), to 281 µm at 66 days (P < .01) and to 133 µm at 88 days (P < .05) after 8 s of radiofrequency energy application. Though radiofrequency energy may induce transient osteonecrosis in the superficial zone of the subchondral bone, the results of this study suggest that post-arthroscopic osteonecrosis appears to be of only modest risk given the current clinical application in humans.

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“…The RF probe delivers a controlled amount of energy resulting in precise tissue ablation, whereas mechanical shavers may not allow similar precise targeting of chondromalacic fronds or fibrillations (3). Therefore, thermal energy is believed to provide a smoother surface, with improved surgical access to seal the damaged articular cartilage, which may decrease the tendency for further delamination and reduce the release of proteoglycan and collagen fragments that promote intraarticular inflammation (2)(3)(4). Heat application first causes the loss of fibrillation and later shrinkage of the surrounding cartilage.…”

Section: Discussionmentioning

confidence: 98%

“…A common treatment for these lesions is to debride and smooth the damaged articular cartilage surface with a mechanical shaver to achieve a stable surface and remove any loose flaps. In the last few years, the use of RF-generating energy devices in arthroscopic surgery has been advocated (2)(3)(4). The RF probe delivers a controlled amount of energy resulting in precise tissue ablation, whereas mechanical shavers may not allow similar precise targeting of chondromalacic fronds or fibrillations (3).…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, unstable cartilage lesions are treated arthroscopically, using mechanical instrumentation. In the last few years, the use of radiofrequency (RF)-generating energy devices in arthroscopic surgery has been advocated (2)(3)(4). On the other hand, percutaneous RF ablation, initially described as a primary treatment for osteoid osteoma in 1992, and now considered as its treatment of choice, is a minimally invasive procedure with outcomes comparable to surgery but with fewer complications and faster recovery time (5)(6)(7)(8).…”

mentioning

confidence: 99%

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