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The purpose of this study was to examine the in vitro effects of three radiofrequency energy devices (two bipolar devices and one monopolar device) for the performance of thermal chondroplasty. Thirty-two fresh bovine femoral osteochondral sections (approximately 3 x 4 x 5 cm) from eight cows were divided into four groups (three treatment patterns and one sham-operated group with eight specimens per group). The three treatment patterns consisted of 1) radiofrequency energy delivered by a mechanical jig at 1 mm/sec in a contact mode (50 g of pressure), 2) radiofrequency energy delivered by a mechanical jig at 1 mm/sec in a noncontact mode (1 mm between probe tip and articular cartilage surface), and 3) radiofrequency energy smoothing of abraded cartilage during arthroscopic visualization. Thermal smoothing of the abraded cartilage surface was accomplished with all three devices. Significant chondrocyte death, as determined by confocal laser microscopy and cell viability staining, was observed with each device. The bipolar radiofrequency systems penetrated 78% to 92% deeper than the monopolar system. The bipolar systems penetrated to the level of the subchondral bone in all osteochondral sections during arthroscopically guided paintbrush pattern treatment. Radiofrequency energy should not be used for thermal chondroplasty until further work can establish consistent methods for limiting the depth of chondrocyte death while still achieving a smooth articular for thermal chondroplasty until further work can establish consistent methods for limiting the depth of chondrocyte death while still achieving a smooth articular surface.

The purpose of this study was to compare joint capsular healing after two delivery patterns of monopolar radiofrequency energy: 1) uniform treatment of the joint capsule (paintbrush pattern) and 2) multiple single linear passes (grid pattern). First, an in vitro study was performed to compare the percent shrinkage of these two treatment patterns using the femoropatellar joints (stifles) of six sheep. Monopolar radiofrequency energy (settings, 70 degrees C/15W) was applied to the lateral joint capsule; the treated area was approximately 10 x 10 mm. There was no significant difference in shrinkage between the grid (27% +/- 8.7%) and paintbrush (29% +/- 7.9%) patterns. In the in vivo study, stifles of 24 sheep were randomly assigned to the paintbrush or the grid pattern groups and treatment was performed arthroscopically. Sheep were sacrificed immediately after surgery, or at 2, 6, or 12 weeks after surgery. At 6 weeks after surgery, confocal microscopy demonstrated that treated areas had almost completely repaired in the grid group; some nonviable areas were still present in the paintbrush group. Mechanical testing at 6 weeks indicated that joint capsule in the grid group had better mechanical properties than capsule in the paintbrush group. This study revealed that radiofrequency treatment of joint capsule in a grid pattern allowed faster healing than tissue treated in a paintbrush pattern.

The purpose of this study was to evaluate the thermal effect of monopolar radiofrequency energy, a potential treatment means for joint instability, on the mechanical, morphologic, and biochemical properties of joint capsular tissue in an in vivo ovine model. The energy was applied arthroscopically to the synovial surface of the femoropatellar joint capsule of 24 sheep. The sheep were sacrificed at 0, 2, 6, and 12 weeks after surgery (6 per group). Monopolar radiofrequency energy initially caused a significant decrease in tissue stiffness and an increase in tissue relaxation properties, followed by gradual improvement in the tissue's mechanical properties by 6 weeks after surgery. Microscopic examination illustrated that radiofrequency energy initially caused collagen hyalinization and cell necrosis, followed by active tissue repair. Biochemical analysis revealed that treated collagen was significantly more trypsin-susceptibile than untreated collagen at 0 and 2 weeks after surgery, indicating early collagen denaturation. This study demonstrated that this treatment initially caused a significantly deleterious effect on the mechanical properties of the joint capsule, which was associated with partial denaturation of joint capsular tissue. This was followed by gradual improvement of the mechanical, morphologic, and biochemical properties of the tissue over time.

The purpose of this in vivo study was to analyze the short-term tissue response of joint capsule to monopolar radiofrequency energy and to compare the effects of five power settings at 65 degrees C on heat distribution in joint capsule. In 12 mature Hampshire sheep, the medial and lateral aspects of both stifles were treated with monopolar radiofrequency energy under arthroscopic control in a single uniform pass to the synovial surface. The radiofrequency generator power settings were 0, 10, 15, 20, 25, and 30 watts (N = 8/group). The electrode tip temperature was 65 degrees C. Histologic analysis at 7 days after surgery revealed thermal damage of capsule at all radiofrequency power settings. The lesion's cross-sectional area, depth, vascularity, and inflammation were commensurate with radiofrequency power. Tissue damage was indicated by variable inflammatory cell infiltration, fusion of collagen, pyknosis of fibroblasts, myonecrosis, and vascular thrombosis, whereas synovial hyperplasia, fibroblast proliferation, and rowing of sarcolemmal nuclei demonstrated regenerative processes. This study revealed that radiofrequency power settings and heat loss through lavage solution play a significant role in heat distribution and morphologic alterations in joint capsule after arthroscopic application of monopolar radiofrequency energy.