Abstract
BackgroundRadio frequency ablation devices have found a widespread application in arthroscopic surgery. However, recent publications report about elevated temperatures, which may cause damage to the capsular tissue and especially to chondrocytes. The purpose of this study was the investigation of the maximum temperatures that occur in the ankle joint with the use of a commercially available radio frequency ablation device.MethodsSix formalin-fixed cadaver ankle specimens were used for this study. The radio frequency device was applied for 120 s to remove tissue. Intra-articular temperatures were logged every second for 120 s at a distance of 3, 5 and 10 mm from the tip of the radio frequency device. The irrigation fluid flow was controlled by setting the inflow pressure to 10 mmHg, 25 mmHg, 50 mmHg and 100 mmHg, respectively. The controller unit voltage setting was set to 1, 5 and 9.ResultsMaximum temperatures exceeding 50 °C/122 °F were observed for all combinations of parameters, except for those with a pressure of 100 mmHg pressure. The main critical variable is the pressure setting, which is highly significant. The controller unit voltage setting showed no effect on the temperature measurements. The highest temperature was 102.7 °C/215.6 °F measured for an irrigation flow of 10 mmHg. The shortest time span to exceed 50 °C/122 °F was 3 s.ConclusionIn order to avoid temperatures exceeding 50 °C/122 °F in the use of radio frequency devices in arthroscopic surgeries of the ankle joint, it is recommended to use a high irrigation flow by setting the pressure difference across the ankle joint as high as feasible. Even short intervals of a low irrigation flow may lead to critical temperatures above 50 °C/122 °F.Level of EvidenceLevel II, diagnostic study.
Highlights
Radio frequency ablation devices have found a widespread application in arthroscopic surgery
Recent publications have shown dermal burns of patients due to hot water spilling originating from the Radio frequency (RF) ablation process and there are some cases of glenohumeral chondrolysis after labral repair in hip arthroscopy [1–7]
It is obvious that low pressure is not an option for ankle joint RF ablation - independent of the voltage setting
Summary
Radio frequency ablation devices have found a widespread application in arthroscopic surgery. The purpose of this study was the investigation of the maximum temperatures that occur in the ankle joint with the use of a commercially available radio frequency ablation device. Arthroscopic surgery of the ankle joint is widespread and tissue ablation is one of the main indications in the “Soccer’s Ankle” or anterior impingement. In this condition, fibrous tissue causes pain above the anterior aspect of the ankle joint and the removal of this tissue is an Ahrens et al BMC Musculoskeletal Disorders (2018) 19:413 hot water, gas and denatured material may escape into the joint cavity where it might lead to unwanted increased local temperatures. Only limited data exists on the effects of RF ablation in the ankle joint, where especially the resection of hypertrophic synovia is useful and frequently used [12]
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