Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study

Abstract

Both mechanical shavers and radiofrequency-based devices are used to treat symptomatic partial thickness chondral lesions. Controversy exists as to which mode of treatment provides better outcomes. The purpose of this study was to compare clinical results after bipolar radiofrequency-based chondroplasty (RFC) to mechanical shaver debridement (MSD). Patients (n = 60) included in the study presented with knee pain associated with a medial meniscus tear and idiopathic ICRS grade III defect of the medial femoral condyle. Patients who had osteoarthritis, grade II or higher cartilage defects of the tibial joint surface, the lateral compartment, or the femoro-patellar joint, or had previously undergone surgery on the affected knee were excluded. Patients underwent partial meniscectomy; during the procedure, they were randomly assigned to receive bipolar RFC (Paragon, ArthroCare Corporation, Austin, TX) or MSD (Full radius resector LR 4.85 x 12.5 cm), Arthrex, Naples, FL). Postoperatively, the same physiotherapist provided instructions for a daily 2-h home training program consisting of isometric, isotonic, and leg lifting exercises; patients were provided the option of using crutches. Clinical outcomes were assessed using the Tegner score, visual analogue scale (VAS) score, and Knee and Osteoarthritis Outcome Score (KOOS) assessment, which consists of five principal domains including pain, symptoms, function in daily living (ADL), and knee related quality of life (QOL), where a score of 0 indicates extreme symptoms and 100 represents no symptoms. Age and time from injury onset did not differ significantly between the RFC and MSD groups (43 +/- 10 vs. 44 +/- 9 years, P = 0.732; 8 +/- 3 vs. 7 +/- 4 months, P = 0.279). No complications or adverse events were observed. Preoperatively, mean (+/-SD) scores for all KOOS principal domains were <20 and did not differ significantly (P > 0.05) between treatment groups. Postoperatively, the RFC patients returned to activity significantly earlier than MSD patients (17 +/- 7 vs. 22 +/- 6 days, P = 0.002). VAS pain scores at 6 h, 24 h, 6 weeks, and 1 year were significantly (P < 0.001) lower for the RFC group than for the MSD group (4 +/- 2, 2 +/- 0.5, 2 +/- 1, 2 +/- 1 vs. 8 +/- 1, 4 +/- 1, 4 +/- 1, 3 +/- 1, respectively). At 1 year, RFC patients had significantly better Tegner score (4.1 +/- 0.8 vs. 2.8 +/- 0.6, P < 0.001) and KOOS domain scores for pain, symptoms, ADL, QOL, respectively (81.1 +/- 8, vs. 59.4 +/- 12.8; 80.7 +/- 7.5 vs. 59.6 +/- 7.5; 81.5 +/- 6.5 vs. 60.1 +/- 6.9; 80 +/- 10 vs. 61.3 +/- 12.5; P < 0.001) than MSD patients. Significantly fewer RFC patients (2% vs 23%, p = 0.026) reported using NSAIDS for knee pain at 1 year. Patients undergoing radiofrequency-based chondroplasty for ICRS grade III medial femoral condyle chondral lesions in conjunction with partial meniscectomy had significantly better clinical outcomes through 1 year than patients with similar pathology receiving chondral debridement using the mechanical shaver.

The potential utility of high-intensity ultrasound to treat osteoarthritis

“…Current treatment of meniscus or cartilage damage includes the intra-articular removal of damaged tissue with mechanical shavers 90,91 , saline jets 92 , and radiofrequency tools 90e92 . Ultrasound has been used to remove tissue by homogenization, debridement and/or thermal ablation 75,93 .…”

Effect of Nell-1 Delivery on Chondrocyte Proliferation and Cartilaginous Extracellular Matrix Deposition

“…Current therapies of using autografts and prosthetics are associated with problems including inadequate number of donor organs, donor-site morbidity, and limited durability of prosthetics. [4][5][6][7][8] Cell=growth-factor-based tissue engineering approaches are attractive alternatives to surgical interventions. A common strategy uses a three-dimensional (3D) scaffold to deliver growth factors to promote differentiation and chondrogenesis of locally confined autologous progenitor cells.…”

Antimicrobial Effects of Plasma-mediated Bipolar Radiofrequency Ablation on Bacteria and Fungi Relevant for Wound Infection

“…Plasma-mediated bipolar radiofrequeney ablation (PbRf ablation), eommonly referred to as Coblation®, is a method for Volumetrie soft tissue removal, whieh is established in several surgieal fields, sueh as arthroseopy, spinal surgery, tumour reseetion, and ear, nose and throat surgery (12)(13)(14)(15). The teehnique is based on indueing a bipolar radiofrequeney eurrent between two eleetrodes in a eonduetive medium, sueh as saline, and thus ereating a physieal plasma field that is able to break moleeular bonds and dissolve tissue at relatively low temperatures (16,17).…”

“…Physieal plasma is regarded as a distinet state of matter and is not to be eonfused with the physiologieally well-known blood plasma. PbRf ablation has been elinieally assoeiated with safe and effeetive tissue removal and has been suggested for use in wound treatment (12)(13)(14)(15). The teehnique has also been used by Lee et al (18) for wound debridement in a ease series of 25 ehronie wound patients with good results and eomplete elosure of all wounds within 6-8 weeks.…”