Radiofrequency energy treatment effects on articular cartilage

Abstract

Partial-thickness cartilage erosion and fibrillation is commonly encountered during arthroscopic examination. These changes may occur secondary to acute injury or as a result of slow degenerative changes associated with aging. Unfortunately, no one technique has the versatility to allow the orthopaedic surgeon to debride partial-thickness lesions, prevent their recurrence, and halt their progression. Historically, radiofrequency energy (RFE) has been used in the fields of neurosurgery, oncology, cardiology, and, more recently, in musculoskeletal surgery for arthroscopic capsulorrhaphy procedures. RFE has the advantages of being safe, relatively inexpensive, and easy to use via arthroscopy. In addition, at least 5 major manufacturers now provide an array of probes designed for arthroscopic application. Although the effects of RFE on the joint capsule are well documented through controlled research, there are few reports on its effects on articular cartilage and those reports that are present in the peer-reviewed literature provide conflicting information. RFE can rapidly contour and smooth fine fibrillations associated with chondromalacic cartilage, but it does not appear to be a tool that can be used safely for ablating larger fronds (>1.0 mm) and stabilizing delaminated areas. Bipolar probes, at recommended settings, operate at temperatures in excess of 100°C, often result in rapid chondrocyte death to depths greater than 2.0 mm from the articular surface, and should not be used for thermal chondroplasty. RFE with temperature control, though far safer than bipolar RFE, kills cells to a depth of approximately 0.75 mm and further evaluation of its safety and long-term efficacy should be performed before it can be recommended for clinical use. Although anecdotal reports indicate that RFE may have application for performing thermal chondroplasty, further in vitro and in vivo studies are required to determine the optimal settings and guidelines for its use.