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Radiofrequency
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Radiofrequency

The most common surgical procedure carried out in patients with injuries to their joint (‘articular’) cartilage is arthroscopic chondroplasty or ‘removal of the diseased fragments’, otherwise known as cleaning, debridement, or ‘ablation’.

These pieces can cause damage and inflammation to the joint, resulting in symptoms of pain, ‘catching’ of the joint during movement, and swelling. Radiofrequency is a simple, safe and reliable method of treating articular cartilage damage in the joint.

Radiofrequency is a more refined technique than previously used approaches for removing diseased articular cartilage fragments from a damaged joint.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about radiofrequency treatment, as well as anyone interested in cartilage problems.

What is Radiofrequency?

The traditional method employed to perform a chondroplasty was to use a motorised shaver to help remove the fragments of diseased cartilage from the joint and contour the edges of the remaining surface. Because the shaver is a metal blade operating at high speed, there was some associated damage to healthy cells due to both the mechanical effects of the shaver and the production of heat, which was inevitable with this kind of device.

Radiofrequency is a kind of energy that can create a ‘plasma layer’ at the tip of a device. This allows the highly focused removal of unhealthy or diseased tissue at a molecular level, with very little heat produced in surrounding, healthy tissues. Consequently, fragments of diseased cartilage can be safely removed. The by-products of radiofrequency include nitrogen, water and carbon dioxide, which are usually removed from the joint with a suction device.

Radiofrequency devices came into the market in the 1990s to help surgeons maximise the removal of damaged cartilage and minimise the collateral damage to surrounding healthy cartilage. However, the energy profile and the effects on cartilage with the different devices were initially not well understood, which caused some early complications with this technique. Consequently, the energy profile of each radiofrequency device needs to be fully understood by the surgeon to achieve the desired result.

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Radiofrequency

What are the advantages and disadvantages of Radiofrequency?

What are the advantages of Radiofrequency?

Over the past 10 years, there have been a number of studies both in humans and animals showing that, when used with the proper manufacturer settings and with a proper technique, radiofrequency is not only safe but may be a better tool than a motorised shaver alone. Specifically, radiofrequency has less chance of collateral damage and better clinical outcomes.

As well as being a more refined device that produces less collateral damage and can be used in smaller areas of the joint, some clinical studies have shown that radiofrequency may stimulate a healing response in the damaged area. This is not seen when a motorised shaver is used alone, unless the underlying bone is roughened, or ‘abraded’.

What are the disadvantages of Radiofrequency?

The potential risk with radiofrequency is to further damage the surrounding healthy cartilage when the device is not used in the proper (ablation) mode. In the thermal mode, these devices act similarly to the ‘electrocautery’ devices used to seal blood vessels during surgery, and produce excessive heat that may damage articular cartilage cells.

Improper technique and inadequate irrigation may also place the healthy cartilage cells at risk. It is therefore essential that the operating surgeon is familiar with the device’s energy profile, and how the device works in each mode.

Frequently Asked Questions (FAQs)

Is it a well-established technique?

As before, we have seen that there is abundance of information to support the use of radiofrequency for removing diseased articular cartilage fragments from a damaged joint.

Is radiofrequency safe?

As discussed in the Advantages and Disadvantages sections above, data from more than 10 years of study in animals and humans have shown that radiofrequency is a safe technique, causing less collateral damage than, for example, a motorised shaver.

Further reading

There have been a number of papers that have been published on the topic of radiofrequency:

  • Spahn G, Kahl E, Muckley T, Hofmann GO, Klinger HM. Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study. Knee Surg Sports Traumatol Arthrosc. 2008;16(6):565-573.
  • Voloshin I, Morse KR, Allred CD, Bissell SA, Maloney MD, DeHaven KE. Arthroscopic evaluation of radiofrequency chondroplasty of the knee. Am J Sports Med. 2007;35(10):1702-1707.
  • Owens BD, Stickles BJ, Balikian P, Busconi BD. Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy. 2002;18(2):151-155.

The following publication gives more information on the basic science of radiofrequency:

  • Amiel D, Ball ST, Tasto JP. Chondrocyte viability and metabolic activity after treatment of bovine articular cartilage with bipolar radiofrequency: an in vitro study. Arthroscopy. 2004;20(5):503-510.

For further and more detailed information on the outcomes and comparative performance of radiofrequency, see the following articles:

  • Allen RT, Tasto JP, Cummings J, Robertson CM, Amiel D. Meniscal debridement with an arthroscopic radiofrequency wand versus an arthroscopic shaver: comparative effects on menisci and underlying articular cartilage. Arthroscopy. 2006;22(4):385-93.
  • Cetik O, Cift H, Comert B, Cirpar M. Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series. Knee Surg Sports Traumatol Arthrosc. 2009;17(1):24-9.
  • Kaplan L, Uribe JW. The acute effects of radiofrequency energy in articular cartilage: an in vitro study. Arthroscopy. 2000;16(1):2-5.
  • Kaplan LD, Ernsthausen JM, Bradley JP, Fu FH, Farkas DL. The thermal field of radiofrequency probes at chondroplasty settings. Arthroscopy. 2003;19(6):632-40.
  • Lotto ML, Lu Y, Mitchell ME, Wright EJ, Lubowitz JH, Markel MD. An ex vivo thermal chondroplasty model: the association of a char-like layer and underlying cell death. Arthroscopy. 2006;22(11):1159-62.
  • Lotto ML, Wright EJ, Appleby D, Zelicof SB, Lemos MJ, Lubowitz JH. Ex vivo comparison of mechanical versus thermal chondroplasty: assessment of tissue effect at the surgical endpoint. Arthroscopy. 2008;24(4):410-5.
  • Spahn G, Klinger HM, Muckley T, Hofmann GO. Four-year results from a randomized controlled study of knee chondroplasty with concomitant medial meniscectomy: mechanical debridement versus radiofrequency chondroplasty. Arthroscopy. 2010;26(9 Suppl):S73-80.
  • Turner AS, Tippett JW, Powers BE, Dewell RD, Mallinckrodt CH. Radiofrequency (electrosurgical) ablation of articular cartilage: a study in sheep. Arthroscopy. 1998;14(6):585-91.
  • Zoric BB, Horn N, Braun S, Millett PJ. Factors influencing intra-articular fluid temperature profiles with radiofrequency ablation. J Bone Joint Surg Am. 2009;91(10):2448-54.
The most common surgical…
ICRShttps://cartilage.org/content/uploads/icrs.jpg
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