Abstract
The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm2 was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq = 3.8 ± 1.1 μm. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq = 27.3 ± 4.9 μm. However, with increased smoothing, an augmentation in chondrocyte death up to 95% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage.
Highlights
In recent years, treatment of cartilage degeneration with radiofrequency energy (RFE) remains controversial
We evaluated the smoothness of the cartilage surface generated by different RFE treatment patterns, as well as the vitality and apoptosis of the cartilage resident cells using a detailed quantitative analyses [16]
Quantitative analysis of this group demonstrates that there is a substantially lower cell death rate compared to samples subjected to RFE (Figure 4 and Table 1)
Summary
Treatment of cartilage degeneration with radiofrequency energy (RFE) remains controversial. Many experimental studies have shown that using RFE can lead to severe chondrocyte damage, if temperatures above 45°C are applied directly to the cartilage layer [1,2,3]. The chondrocyte death rate is proportional to the temperature increase. Edwards et al reported a 40% chondrocyte death rate at a temperature of 55°C and almost 100% at 65°C [4]. The temperature elevation during an arthroscopic procedure is time-dependent, as the longer the RFE electrode is activated, the higher is the temperature. Several studies demonstrated that an activation of the energy flow between 3 and 10 seconds should be safe enough for use in arthroscopy [5, 6]
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