Vet Comp Orthop Traumatol 2008; 21(01): 41-48
DOI: 10.3415/VCOT-07-01-0004
Original Research
Schattauer GmbH

Comparison of radiofrequency treatment and mechanical debridement of fibrillated cartilage in an equine model

R. B. Edwards
1   Fairfield Equine Associates, Newtown, Connecticut, USA
,
Y. Lu
2   Comparative Orthopaedic Research Laboratory, Departments of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
,
B. J. Cole
3   Departments of Orthopaedics and Anatomy, Rush Cartilage Restoration Center, Rush Medical College, Rush-Presbyterian St.-Luke's Medical Center, Chicago, Illinois, USA
,
P. Muir
1   Fairfield Equine Associates, Newtown, Connecticut, USA
,
M. D. Markel
2   Comparative Orthopaedic Research Laboratory, Departments of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
› Author Affiliations
Further Information

Publication History

Received 09 January 2007

Accepted 20 March 2007

Publication Date:
17 December 2017 (online)

Summary

Objective: To compare a radiofrequency energy (RFE) prototype probe to mechanical debridement (MD) and a commercially available RFE system used for chondroplasty in the treatment of an experimentally created partial thickness cartilage lesion in horses. The study design was experimental, randomized complete block, n=8, using fifteen mature ponies. Methods: Grade 2 to 3 cartilage lesions were prepared in both patellae. After 10 months duration, the injuries were used to study the effects of MD, a commercially available bipolar RFE device (CoVac 50; ArthroCare Corporation) and a prototype monopolar RFE device (Smith & Nephew Endoscopy). Six months after treatment the patellae were examined for chondrocyte viability and cartilage structure. Results: Mean depth of cell death was significantly different among groups (controls, MD <prototype<CoVac 50) (P<0.05). Total histologic scores did not demonstrate any significant differences among the controls, MD and prototype RFE groups, which were all better than the CoVac 50 scores (P<0.05). There was a trend for the prototype RFE probe treated regions to have better surface structural characteristics than MD (P=0.11). Cartilage thickness was greater for the prototype RFE group than all other groups, and was the thinnest for the CoVac 50 group (P<0.05). Conclusion: When thermal chondroplasty is performed with a power-controlled prototype RFE probe, there is a better surface smoothing effect compared to MD, which causes less chondrocyte death and has the potential to maintain thicker cartilage compared to the commercially available RFE system.

 
  • References

  • 1 Frisbie DD. Principles of treatment of joint disease. In: Auer JA, Stick JA. (eds) Equine Surgery. (3rd ed) St. Louis: Saunders Elesevier; 2006. pp. 1055-1073.
  • 2 Uribe Uribe. Electrothermal chondroplasty--bipolar. Clin Sports Med 2002; 21: 675-685.
  • 3 Khan Khan, Dillingham MF. Electrothermal chon- droplasty--monopolar. Clin Sports Med 2002; 21: 663-674.
  • 4 Thabit III. Therapeutic heat: a historical perspective. OperTech Sports Med 1998; 6: 118-119.
  • 5 Dillingham M. Arthroscopic electrothermal surgery of the knee. Oper Tech Sports Med 1998; 6: 154-156.
  • 6 Fanton GS. Arthroscopic electrothermal surgery of the shoulder. Oper Tech Sports Med 1998; 6: 139-146.
  • 7 Oloff LM, Bocko AP, Fanton G. Arthroscopic monopolar radiofrequency thermal stabilization for chronic lateral ankle instability: a preliminary report on 10 cases. J Foot Ankle Surg 2000; 39: 144-153.
  • 8 Thabit III G. Arthroscopic monopolar radiofre- quency treatment of chronic anterior cruciate ligament instability. Oper Tech Sports Med 1998; 6: 157-160.
  • 9 Kaplan L, Uribe JW, Sasken H. et al. The acute effects of radiofrequency energy in articular cartilage: an in vitro study. Arthroscopy 2000; 16: 2-5.
  • 10 Turner AS, Tippett JW, Powers BE. et al. Radiofrequency (Electrosurgical) ablation of articular cartilage. a study in sheep. Arthroscopy 1998; 14: 585-591.
  • 11 Edwards RB, Lu Y, Kalscheur VL. et al. Thermal chondroplasty of chondromalacic human cartilage: an ex vivo comparison of bipolar and monopolar radiofrequency devices. Am J Sports Med 2002; 30: 90-97.
  • 12 Lu Y, Hayashi K, Hecht P. et al. The effect ofmonopolar radiofrequency energy on partial-thickness defects of articular cartilage. Arthroscopy 2000; 16: 527-536.
  • 13 Lu Y, Edwards RB, Kalscheur VL. et al. Effect of bipolar radiofrequency energy on human articular cartilage: comparison of confocal laser microscopy and light microscopy. Arthroscopy 2001; 17: 117-123.
  • 14 Caffey S, McPherson E, Moore B. et al. Effects of radiofrequency energy on human articular cartilage: an analysis of 5 systems. Am J Sports Med 2005; 33: 1035-1039.
  • 15 Lu Y, Edwards RB, Cole BJ. et al. Thermal chondroplasty with radiofrequency energy: An in vitro comparison of bipolar and monopolar radiofre- quency devices. Am J Sports Med 2001; 29: 42-49.
  • 16 Owens BD, Stickles BJ, Balikian P. et al. Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy 2002; 18: 151-155.
  • 17 Kaab MJ, Bail HJ, Rotter A. et al. Monopolar radiofrequency treatment of partial-thickness cartilage defects in the sheep knee joint leads to extended cartilage injury. Am J Sports Med 2005; 33: 1472-1478.
  • 18 Ryan A, Bertone AL, Kaeding CC. et al. The effects of radiofrequency energy treatment on chon- drocytes and matrix of fibrillated articular cartilage. Am JSports Med 2003; 31: 386-391.
  • 19 Blouin Blouin, Marcus FI. The effect of electrode design on the efficiency of delivery of radiofrequency energy to cardiac tissue in vitro. Pacing Clin Electrophysiol 1989; 12: 136-143.
  • 20 Haines Haines, Watson DD. Tissue heating during radiofrequency catheter ablation: a thermodynamic model and observations in isolated perfused and superperfused canine right ventricular free wall. Pacing Clin Electrophysiol 1089; 12: 962-976.
  • 21 Haines DE, Watson DD, Verow AF. Electrode radius predicts lesion radius during radiofrequency energy heating: validation of a proposed thermodynamic model. Circulation 1990; 67: 124-129.
  • 22 Nath Nath, Haines DE. Biophysics and pathology of catheter energy delivery systems. Prog Cardiovasc Dis 37: 185-204 1995;
  • 23 Nath S, DiMarco JP, Haines DE. Basic aspects of radiofrequency catheter ablation. J Cardiovasc Electrophysiol 1994; 5: 863-876.
  • 24 Lotto ML, Lu Y, Mitchell ME. et al. An ex vivo thermal chondroplasty model: the association of a char-like layer and underlying cell death. Arth- roscopy 2006; 22: 1159-1162.
  • 25 Meyer ML, Lu Y, Markel MD. Effects of radiofrequency energy on human chondromalacic cartilage: an assessment of insulation material properties. IEEE Trans Biomed Eng 2005; 52: 702-710.
  • 26 Edwards RB, Lu Y, Uthamanthil RK. et al. Comparison of mechanical debridement and radiofre- quency energy for chondroplasty in an in vivo equine model of partial thickness cartilage injury. Osteoarthritis Cart 2007; 15: 169-178.
  • 27 Uthamanthil RK, Edwards RB, Lu Y. et al. An in vivo study on the short term effect of radiofrequency energy on chondromalacic patellar cartilage and its correlation with calcified cartilage pathology in an equine model. J Orthop Res 2006; 24: 716-724.
  • 28 Edwards RB, Lu Y, Uthamanthil RK. et al. Comparison of mechanical debridement and radiofrequency energy for chondroplasty in an in vivo equine model of partial thickness cartilage injury. Osteoarthritis Cartilage 2007; 15: 169-178.
  • 29 Edwards RB, Lu Y, Rodriguez Eetal. Thermomet- ric determination of cartilage matrix temperatures during thermal chondroplasty: comparison of bipolar and monopolar radiofrequency devices. Arthroscopy 2002; 18: 339-346.
  • 30 Dumont J, Ionescu M, Reiner A. et al. Mature full- thickness articular cartilage explants attached to bone are physiologically stable over long-term culture in serum-free media. Connect Tissue Res 1999; 40: 259-272.
  • 31 Grogan SP, Aklin B, Frenz M. et al. In vitro model for the study of necrosis and apoptosis in native cartilage. J Pathol 2002; 198: 5-13.
  • 32 Mainil-Varlet P, Monin D, Weiler C. et al. Quantification of laser-induced cartilage injury by confocal microscopy in an ex vivo model. J Bone Joint Surg Am 2001; 83: 566-571.
  • 33 Zuger BJ, Ott B. Mainil-Varlet Petal. Laser solder welding of articular cartilage: tensile strength and chondrocyte viability. Lasers Surg Med 2001; 28: 427-434.
  • 34 Tew SR, Kwan AP, Hann A. et al. The reactions of articular cartilage to experimental wounding: role of apoptosis. Arthritis Rheum 2000; 43: 215-225.
  • 35 Lu Y, Edwards RB, Markel MD. Effects of electrothermal energy on cartilage. In: Mirzayan R. (ed) Cartilage Injury in the Athlete. New York, NY: Thieme New York; 2006. pp. 31-45.
  • 36 Federico DJ, Reider B. Results of isolated patellar debridement for patellofemoral pain in patients with normal patellar alignment. Am J Sports Med 1997; 25: 663-669.
  • 37 Hunziker Hunziker, Quran TM. Surgical removal of articular cartilage leads to loss of chondrocytes from cartilage bordering the wound edge. J Bone Joint Surg Am 2003; 85 (Suppl. 02) 85-92.
  • 38 Bayliss MT, Howat S, Davidson C. et al. The organization of aggrecan in human articular cartilage. Evidence for age-related changes in the rate of aggregation of newly synthesized molecules. J Biol Chem 2000; 275: 6321-6327.
  • 39 Hogan Hogan, Diduch DR. Progressive articular cartilage loss following radiofrequency treatment of a partial-thickness lesion. Arthroscopy. 2001 17. E24.
  • 40 Diaz SH, Nelson JS, Wong BJ. Rate process analysis of thermal damage in cartilage. Phys Med Biol 2003; 48: 19-29.
  • 41 Lu Y, Edwards RB, Nho S. et al. Lavage solution temperature influences depth of chondrocyte death and surface contouring during thermal chondroplasty with temperature controlled monopolar radiofrequency energy. Am J Sports Med 2002; 30: 667-673.
  • 42 Lu Y, Edwards III RB, Nho S. et al. Thermal chondroplasty with bipolar and monopolar radiofrequency energy: Effect of treatment time on chondrocyte death and surface contouring. Arthroscopy 2002; 18: 779-788.