Radiofrequency in arthroscopic shoulder surgery: a systematic review

Abstract

BackgroundRadiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder.MethodsThis systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: “shoulder,” “rotator cuff,” “biceps,” “acromion” AND “monopolar,” “bipolar,” “ablation,” “coblation,” and “radiofrequency ablation.” The title and abstract review were performed independently. Any discrepancies were addressed through open discussion.ResultsA total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case.DiscussionShoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.

The use of radiofrequency in equine orthopedic surgery

“…Studies investigating the effect of RFE on the joint environment are hindered as the temperature profile and depth of penetration following RFE exposure vary significantly with the device used, the ablation settings, the flow of irrigation fluid, and the application technique. 30 This makes it difficult to make reliable comparisons between the studies and assess their relevance to clinical practice, as there is no standardized technique or instrument setting established. Additionally, much of the published literature focuses on the early first-generation RF devices, and there are limited data evaluating the effects of exposure to modern plasma RF instruments on chondrocyte and matrix viability.…”

“…More recently, 85 RFE knee chondroplasties assessed 2 years postoperatively identified no complications related to thermal injury, with the functional outcome being correlated with the quality of chondral and meniscal tissue at the time of surgery. 33 Similarly, a systematic review 30 of 63 studies investigating RFE in shoulder arthroscopy concluded that the technology represents a more efficacious and economic treatment than traditional therapies; however, practitioners should be cognizant of the potential for thermal injuries.…”

“…RFE use in the hip is mainly restricted to soft thermal release procedures and ligament debridement. 30 RFE use in humans is largely limited to arthroscopy of the knee joint or soft tissue procedures involving debridement, resection, and techniques for thermal joint capsule shrinkage. 27 While many clinical studies prove the effectiveness and safety of RF, there is limited evaluation of the long-term biochemical changes to the cartilage of treated joints, which is consequently an area requiring further investigation before RFE can be recommended.…”