Thermal Surgery: Basic Science and Biologic Considerations

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Summary:Thermal modification of joint capsule and ligament has gained great popularity among orthopaedic surgeons as a treatment method for joint instability. Heating joint capsular tissue to approximately 70°C to 80°C by laser or radiofrequency energy produces significant dimensional alterations (shrinkage and thickening) of the tissue treated, resulting in postoperative stabilization of the joint. In vitro experimental studies have demonstrated that joint capsular tissue is significantly shortened by thermal energy, although significant loss of the tissue's mechanical properties occurs after this treatment. In vivo experimental studies have demonstrated initial deleterious effects of thermal energy application, followed by an active reparative response, with concomitant improvement of mechanical properties. Other studies have shown that despite significant immediate postoperative tissue shrinkage, the tissue stretches over time if it is subjected to physiologic loading. Currently, radiofrequency applications to other musculoskeletal tissues such as cartilage are being explored. Thermal modification of musculoskeletal tissues has the potential to enhance joint stability and may become a prominent modality in the treatment of joint disorders. However, it should be emphasized that thermal treatment does cause initial deleterious effects to the tissue's properties, and that long-term results have yet to be evaluated.

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