Thermal chondroplasty: effect of bipolar and monopolar radio frequency energy

Abstract

Cartilage fibrillation is commonly associated with injury and long-term degeneration. Contouring the articular surface with radiofrequency energy (RFE) may stabilize the surface, and improve clinical function, but subchondral bone injury has been reported in some patients. The purpose of this research was to document the effects of bipolar and monopolar RFE on articular cartilage. Bipolar RFE and monopolar RFE treatment of abraded bovine cartilage was investigated in an in vitro model. Bipolar RFE caused greater chondrocyte death than monopolar RFE, (bipolar RFE: 1700-?m; monopolar RFE: 800-?m) (p<0.05). Both bipolar RFE and monopolar RFE contoured the articular surface but the depth of chondrocyte death raised concerns regarding the clinical application of RFE. Further work investigated the arthroscopic application of bipolar RFE and monopolar RFE on human chondromalacic cartilage in vitro. Both devices smoothed the fibrillated surface, but bipolar RFE caused increased depth of chondrocyte death compared to monopolar RFE (bipolar RFE 2100-?m; monopolar RFE 620-?m (p<0.05). Fluoroptic thermometry has demonstrated cartilage matrix temperatures exceeding 70° C 2-mm below the articular surface during the application of bipolar RFE. The clinical use of the bipolar RFE systems available to date will likely result in unacceptable chondrocyte death and subchondral injury. While RFE demonstrates some promise for the management of cartilage injury, further work must be completed to define the parameters for its application.