[Basic principles of radiosurgical systems and their applications in arthroscopy].
Electrosurgical devices are being used in each medical subdiscipline,and, only recently, they have found widespread distribution in the field of arthroscopic surgery, as well. This development is mainly due to the construction of small and relatively cheap devices that work in a bipolar mode at high frequency. A local plasma field is being built up between the electrodes at the tip of the probe which has enough energy to allow the disintegration of molecules within the treated tissue. The local current flow helps to minimize the numerous disadvantages of monopolar or Laser-based systems. Nevertheless, there is considerable discrepancy between the wide spectrum of clinical use on the one hand and the knowledge of mid- or even long-term biological effects on the treated tissue on the other. So far, clinical and experimental studies exist for the frequent indications of chondroplasty and capsular or ligamental shrinkage. But, still, there is no agreement upon these indications. Studies have shown a considerable number of dead chondrocytes or fibroblasts within a depth of several millimeters within the tissue of the joint capsule or the articular cartilage after electrosurgical treatment. But especially these cells are thought to be essential for the maintenance of the tissue. While the results of other studies seem to be less critical, some authors propose not to use electrosurgery in arthroscopy at all, until further studies prove the safety of these devises. Unfortunately, there is no reliable feedback system for the temperature increase within the treated tissue or other important parameters. The use of these instruments affords a high degree of experience from a skilled arthroscopic surgeon.
Wienecke
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Klinik für Unfall- und Wiederherstellungschirurgie, Henriettenstiftung Hannover. Philipp.Lobenhoffer@Henriettenstiftung.de
Lobenhoffer
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D000818:Animals; D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D002986:Clinical Trials as Topic; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D017746:Joint Capsule / Q000601:surgery; D007593:Joint Instability / Q000601:surgery; D008022:Ligaments / Q000601:surgery; D008297:Male; D011817:Rabbits; D016634:Radiosurgery; D012756:Sheep; D000074402:Synovectomy; D013997:Time Factors