The Use of Radiofrequency Devices for Chondral Debridement

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SummaryDebridement remains the primary treatment of partial thickness (modified Outerbridge grade 2 and 3) articular cartilage (AC) lesions. The surgical objective of debridement is to remove the loose degenerated cartilage leaving a stable edge and a smooth articular surface. Mechanical debridement of these lesions using an arthroscopic shaver may result in an irregular surface and achieving edge stability often necessitates removal of healthy AC. Chondral debridement using radiofrequency generated energy presents an attractive alternative. At relatively low temperatures (60°C) fibrillated articular cartilage can be modified in a manner similar to capsular tissue with shrinkage or contracture of the fronds. At higher voltage levels, bipolar radiofrequency energy (bRFE) produces an ionic vapor layer or plasma that dissociates the molecular bonds of the tissue causing a volumetric ablation or removal of the tissue. The advantages of bRFE debridement of articular cartilage are that it leaves a smooth surface and anneals the cartilage along the edges of the lesions providing stability with minimal debridement. Because of the size and configuration of the probes the accessibility to these lesions not only in the knee but also in multiple joints is enhanced. The use of bRFE on AC remains controversial. In vitro studies both support and decry its use. Recent clinical studies however have demonstrated its safety and effectiveness. An understanding of the mechanism of action of radiofrequency on AC and the proper surgical technique is essential to maximize its effectiveness and safety. As with any surgical cutting device the potential for significant collateral damage exists. More research is required to define the optimal power settings and electrode configurations.

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