Thermal Energy in the Knee

Abstract

ABSTRACT The use of monopolar and bipolar radiofrequency energy has become increasingly popular in the treatment of chondromalacia of the knee. Several in vitro studies have shown that radiofrequency energy application to cartilage can rapidly contour and smooth fine fibrillations associated with chondromalacia. However, confocal laser microscopy and cell viability staining have confirmed a zone of chondrocyte death after thermal chondroplasty. In vitro studies have shown that the amount of cell death is a function of many variables including the type of probe, surgical technique, and lavage solution temperature. The depth of chondrocyte death has been shown to be less with monopolar radiofrequency energy than with bipolar radiofrequency energy, but its clinical benefit remains unproven. Although chondrocytes have some ability to rebound from initial thermal trauma, radiofrequency energy should be used with care until well-designed short- and long-term clinical trials can confirm the safety and efficacy of thermal chondroplasty. The procedure itself is technically easy to perform and is largely operator dependent. Successful outcomes may depend on properly defining the indications and understanding the risks and benefits of radiofrequency energy.