Comparison of Electrothermal Ablation and Electrolyte Plasmalization Devices Based on the Mechanical Properties of Anterior Cruciate Ligament Femoral Attachment Following Partial Debridement: A Biomechanical Study Using a Porcine Model.

Abstract

Purpose This study aimed to clarify whether differences in ablation devices used in the knee joint during partial debridement of the proximal end of the femoral attachment of the anterior cruciate ligament (ACL) affect the mechanical properties of the femur-ACL-tibia complex. Methods Electrothermal ablation was generated from Vulcan for the left knees, and radiofrequency ablation was generated from Werewolf Flow 50 Wand for the right knees. The probes were set to the default setting of 120 W and 150 W for Vulcan and Werewolf Flow 50 Wand, respectively. To mimic partial debridement in remnant tissue-preserving (RTP) ACL reconstruction, the bipolar ablation mode and serpentine movements were employed while in contact with the femoral fan-like extension fibers of the ACL. To simulate the arthroscopic environment, the model was immersed in a saline solution. The probes were applied for 60 s, and their biomechanical properties were evaluated. Results A significant difference was observed in the upper yield load between the two groups (Vulcan group, 107.1 ± 93.4 N; Werewolf group, 177.9 ± 108.8 N; P = 0.045). However, no significant differences were noted in linear stiffness (Vulcan group, 47.6 ± 30.9 N/mm; Werewolf group, 50.1 ± 30.5 N/mm; P = 0.85), maximum load (Vulcan group, 276.2 ± 171.8 N; Werewolf group, 397.7 ± 150.8 N; P = 0.26), or elongation at failure (Vulcan group, 6.1 ± 0.9 mm; Werewolf group, 11.6 ± 10.4 mm; P = 0.20) between the two groups. Conclusion The mechanical properties of the ACL after partial ACL femoral attachment debridement for RTP-ACL reconstruction were better when an electrolyte plasmalization device was used. When performing RTP-ACL reconstruction, surgeons must consider that the device used for partial femoral ACL stump debridement may affect the mechanical properties of the ACL remnant tissue. Clinical relevance When performing RTP-ACL reconstruction, surgeons must consider that the device used for partial femoral ACL stump debridement may affect the mechanical properties of the ACL remnant tissue.