Ex vivo comparison of mechanical versus thermal chondroplasty: assessment of tissue effect at the surgical endpoint.
OBJECTIVE
The purpose of this study was to evaluate tissue effect (tissue removal plus underlying cell death) of two chondroplasty techniques: mechanical debridement (MD) using a rotary shaver blade and thermal chondroplasty using radiofrequency energy (RFE).


METHODS
Forty-eight human chondromalacic cartilage samples were treated with either MD or RFE. Pre- and post-treatment arthroscopic images of the cartilage surface were recorded. Samples were incubated with cell viability stain and visualized with confocal laser microscopy to determine tissue effect. Smoothing was quantitated by three surgeons using a visual analog scale (VAS) as well as a subjective rating regarding whether smoothing was "arthroscopically acceptable."


RESULTS
Tissue effect at the surgical endpoint of arthroscopically acceptable smoothing was 385 microm for MD versus 236 microm for RFE, a significant difference (P < .0001). Mean post-treatment VAS for MD was 2.8 points less smooth than for RFE (P < .0001). Overall, arthroscopically acceptable smoothing was achieved in 90% of RFE samples compared to 49% of MD samples.


CONCLUSIONS
Our results shown that chondroplasty using a RFE probe results in greater smoothing of chondromalacic cartilage in fewer treatment passes and with decreased total tissue effect than MD using a rotary shaver blade.


CONCLUSIONS
If safety and efficacy can be shown in vivo, thermal chondroplasty may represent an alternative for treatment of symptomatic chondromalacia.
Lotto
Marie L
ML
Endoscopy Division, Smith & Nephew, Andover, Massachusetts, USA.
Wright
Emma J
EJ
Appleby
David
D
Zelicof
Steven B
SB
Lemos
Mark J
MJ
Lubowitz
James H
JH
D001182:Arthroscopy / Q000379:methods; D002358:Cartilage, Articular / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery*; D046789:Chondromalacia Patellae / Q000532:radiotherapy* / Q000601:surgery*; D003646:Debridement / Q000295:instrumentation / Q000379:methods; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D006801:Humans; D066298:In Vitro Techniques; D007719:Knee Joint / Q000601:surgery; D016014:Linear Models; D018613:Microscopy, Confocal; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000379:methods; D000078702:Radiofrequency Therapy; D012494:Sampling Studies; D012680:Sensitivity and Specificity