Thermometric determination of cartilage matrix temperatures during thermal chondroplasty: Comparison of bipolar and monopolar radiofrequency devices

doi:10.1053/jars.2002.29893

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 18, Issue 4, April 2002, Pages 339-346

https://doi.org/10.1053/jars.2002.29893 Get rights and content

Abstract

Purpose: To compare cartilage matrix temperatures between monopolar radiofrequency energy (mRFE) and bipolar RFE (bRFE) at 3 depths under the articular surface during thermal chondroplasty. We hypothesized that cartilage temperatures would be higher at all cartilage depths for the bRFE device than for the mRFE device. Type of Study: Randomized trial using bovine cartilage. Methods: Sixty osteochondral sections from the femoropatellar joint of 15 adult cattle were used for this study. Using a custom jig, fluoroptic thermometry probes were placed at one of the following depths under the articular surface: 200 μm, 500 μm, or 2,000 μm. RF treatment was performed either with fluid flow (F) (120 mL/min) or without fluid flow (NF) (n = 5/depth/RFE device/flow; total specimens, 60). Irrigation fluid temperature was room temperature (22°C). Thermometry data were acquired at 4 Hz for 5 seconds with the RF probe off, for 20 seconds with the RF probe on, and then for 15 seconds with the RF probe off. During RF treatment, a 0.79-cm² area (1.0-cm diameter) of the articular surface centered over the thermometry probe was treated in a paintbrush manner in noncontact (bRFE) or light contact (mRFE). Results: Thermal chondroplasty with bRFE resulted in higher cartilage matrix temperatures compared with mRFE for all depths and regardless of fluid flow. Bipolar RFE resulted in temperatures of 95°C to 100°C at 200 μm and 500 μm under the surface, with temperatures of 75°C to 78°C at 2,000 μm. Fluid flow during bRFE application had no effect at 200 μm. Monopolar RFE resulted in temperatures of 61°C to 68°C at 200 μm, 54°C to 70°C at 500 μm under the surface, and 28°C to 30°C at 2,000 μm below the surface. A significant effect of fluid flow during mRFE application occurred at 200 μm (NF, 61°C; F, 63°C) and 500 μm (NF, 53°C; F, 68°C). Conclusions: In this study, we found significant differences between bRFE and a temperature-controlled mRFE device with regard to depth of thermal heating of cartilage in vitro. Bipolar RFE resulted in matrix temperatures high enough (>70°C) to kill cells as deep as 2,000 μm under the articular surface. Fluid flow during thermal chondroplasty had the effect of significantly increasing cartilage matrix temperatures at 200 and 500 μm with the mRFE device. During thermal chondroplasty, bRFE creates greater matrix temperature elevations at equivalent depths and treatment duration than does mRFE. Excessive temperatures generated deep within the cartilage matrix could cause full-thickness chondrocyte death, in vivo.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: pp 339–346

Section snippets

Methods

Sixty osteochondral sections (height, 2.0 cm; diameter, 2.54 cm) harvested from the femoropatellar joint space of 15 healthy, adult cattle were divided into 2 equal groups. Section location (patella and femoral trochlear groove) and animal number were recorded to allow randomization across treatment groups (n = 5/depth/RF device/flow).

Sections were placed in a jig that allowed tip sensing fluoroptic thermocouples (SFF-2; Luxtron Corp, Santa Clara, CA) to be placed tangentially, parallel to the

Results

At each depth, cartilage temperatures were higher in the bRFE group than the mRFE group (P <.05), and at all depths, bRFE resulted in temperatures exceeding 75°C (Table 1, Figs 3 and 4).

. Mean cartilage matrix temperatures of (A) bRFE and (B) mRFE during thermal chondroplasty with irrigation fluid flow (120 mL/min). Temperature measurements were performed with fluoroptic thermometers placed at 200, 500, and 2,000 μm below the articular surface. Data points were recorded at 4 Hz but reported at 1

Discussion

Bipolar RFE caused significantly greater and deeper temperature rises within the cartilage matrix than mRFE during thermal chondroplasty. Importantly, bRFE resulted in sufficiently high temperatures at the deepest depth measured (2,000 μm) to cause chondrocyte death up to and including this depth. Numerous reports have evaluated the effects of heat on osteoblasts, endothelial cells, murine lymphoma cells, neuronal cells, polymorphonuclear leukocytes, and chondrocytes, and have shown that the

Acknowledgements

Acknowledgment: The authors thank John Bogdanske, Jennifer Devitt, David Choi, and Susan Heath for their assistance in this project. In addition, the authors thank Bill Hagquist, a senior instrument specialist in the College of Engineering, and his staff for the construction of the thermometry jig used to complete this work.

References (32)

AS Turner et al.
Radiofrequency (electrosurgical) ablation of articular cartilage: A study in sheep
Arthroscopy
(1998)
L Kaplan et al.
The acute effects of radiofrequency energy in articular cartilage: An in vitro study
Arthroscopy
(2000)
Y Lu et al.
The effect of monopolar radiofrequency energy on partial-thickness defects of articular cartilage
Arthroscopy
(2000)
Y Lu et al.
Effect of bipolar radiofrequency energy on human articular cartilage: Comparison of confocal laser microscopy and light microscopy
Arthroscopy
(2001)
AR Eriksson et al.
Temperature threshold levels for heat-induced bone tissue injury: A vital-microscopic study in the rabbit
J Prosthet Dent
(1983)
SJ Calder et al.
Reduction of temperatures generated by the triple reamer within the femoral head
Injury
(1995)
P Vogel et al.
Evidence of apoptosis in primary neuronal cultures after heat shock
Brain Res
(1997)
FG Shellock et al.
Radiofrequency energy-induced heating of bovine articular cartilage using a bipolar radiofrequency electrode
Am J Sports Med
(2000)
JG Lane et al.
Matrix assessment of the articular cartilage surface after chondroplasty with the holmium:YAG laser
Am J Sports Med
(1997)
P Mainil-Varlet et al.
Quantification of laser-induced cartilage injury by confocal microscopy in an ex vivo model
J Bone Joint Surg Am
(2001)

Y Lu et al.

Thermal chondroplasty with radiofrequency energy: An in vitro comparison of bipolar and monopolar radiofrequency devices

Am J Sports Med

(2001)

RB Edwards et al.

Thermal chondroplasty of chondromalacic human cartilage: An ex vivo comparison of bipolar and monopolar radiofrequency devices

Am J Sports Med

(2002)

HP Benton et al.

Use of adverse conditions to stimulate a cellular stress response by equine articular chondrocytes

Am J Vet Res

(1996)

S Li et al.

Heat Shock-induced necrosis and apoptosis in osteoblasts

J Orthop Res

(1999)

J Utoh et al.

Effects of temperature on phagocytosis of human and calf polymorphonuclear leukocytes

Artif Organs

(1992)

J Utoh et al.

Effects of heat on fragility and morphology of human and calf erythrocytes

J Invest Surg

(1992)

Cited by (64)

Minimally Invasive Surgical Techniques
2018, Equine Surgery, Fifth Edition
Midcarpal Instability: The Role of Wrist Arthroscopy
2017, Hand Clinics
Subacromial temperature profile during bipolar radiofrequency use in shoulder arthroscopy. Comparison of Coblation® vs. VAPR®
2017, Revue de Chirurgie Orthopedique et Traumatologique
Les électrodes bipolaires utilisées en arthroscopie exposent à un risque théorique ex vivo de lésions thermiques. Cependant, les études évaluant les températures in vivo lors de l’utilisation de ces électrodes en arthroscopie sont peu nombreuses et leurs résultats discordants. Le but de notre étude était d’évaluer l’évolution de la température dans l’espace sous-acromial lors d’une arthroscopie de l’épaule en utilisant deux électrodes différentes. Notre hypothèse principale était l’absence de supériorité d’une électrode sur l’autre en termes de variation et de température maximale atteinte. Notre hypothèse secondaire était l’absence d’atteinte d’un seuil de température délétère pour les tissus par la chaleur produite au sein du liquide d’irrigation.
Une étude comparative prospective monocentrique, mono-opérateur, en simple insu a été réalisée. Les systèmes comparés étaient la Coblation^® (Smith-Nephew Inc., Andover, MA, États-Unis) et le système VAPR^® (DePuySynthesMitek Sport Medecine, Raynham, MA, États-Unis). Treize patients opérés d’une arthroscopie d’épaule ont été inclus. Les mesures de température étaient réalisées avec une sonde thermique placée dans l’espace sous-acromial et relevées toutes les 10 secondes pendant 60 secondes avec une utilisation continue du système d’électrocoagulation.
La température de base était en moyenne de 21,4 °C (écart-type : ET = 0,7 °C) dans le groupe VAPR^® et 23,0 °C (ET = 2,2 °C) dans le groupe Coblation^®. Aucune différence significative entre les deux groupes n’était retrouvée durant les 40 premières secondes. Au pic de température à 60 secondes, la température était en moyenne de 25,0 °C (ET = 1,9 °C) pour les patients opérés par VAPR^® et 27,9 °C (ET = 2,8 °C) pour ceux opérés par Coblation^® (p < 0,05).
Peu d’études ont comparé in vivo la température engendrée entre les différentes électrodes en arthroscopie. Des études ex vivo ont montré l’effet délétère de la température au niveau tissulaire, notamment sur les chondrocytes, et insistent sur le rôle capital du flux de l’irrigation sur la diminution de la température. Notre étude montre une différence significative entre les deux électrodes après 50 secondes d’utilisation continue, en faveur du système VAPR^®. Toutefois, les deux électrodes n’augmentent pas la température du liquide d’irrigation au-delà de la limite délétère pour les tissus. Ces systèmes sont sécurisés dans leur utilisation en respectant les données des industriels et en assurant une bonne irrigation.
II (étude prospective comparative randomisée).
Subacromial temperature profile during bipolar radiofrequency use in shoulder arthroscopy. Comparison of Coblation® vs. VAPR®
2017, Orthopaedics and Traumatology: Surgery and Research
The use of bipolar electrodes for arthroscopic procedures carries a theoretical ex vivo risk of inducing burn injuries. Few studies have measured the in vivo temperatures produced by bipolar electrodes during arthroscopy, and their results are conflicting. The objective of this study was to evaluate the temperature profile within the subacromial space during shoulder arthroscopy with two different electrode systems.
The primary hypothesis was that the two electrode systems produced similar temperature variations and peak temperatures. The secondary hypothesis was that neither electrode system produced irrigation-fluid temperatures above the tissue-damage threshold.
A comparative, prospective, single-centre, single-surgeon, single-blind study was conducted to compare the Coblation^® system (Smith&Nephew, Andover, MA, USA) and the VAPR^® system (DePuy Synthes Mitek Sports Medicine, Raynham, MA, USA) in 13 patients undergoing shoulder arthroscopy. A temperature probe inserted into the subacromial space was used to record temperatures at 10-second intervals for 60 seconds during continuous radiofrequency application.
Mean baseline temperature was 21.4 ± 0.7 °C with VAPR^® and 23.0 ± 2.2 °C with Coblation^®. No significant between-group differences were found during the first 40 seconds. The mean peak temperature reached after 60 seconds was 25.0 ± 1.9 °C with VAPR^® and 27.9 ± 2.8 °C with Coblation^® (P < 0.05).
Few studies have compared the in vivo temperatures produced during arthroscopy by different electrode systems. In vivo studies have established that temperature increases can cause tissue damage, particularly to chondrocytes, and that the irrigation flow rate plays a key role in lowering the in vivo temperatures. Our study showed a significant difference between the two electrode systems after 50 seconds of use, with lower temperatures with the VAPR^®. Nevertheless, neither system increased the irrigation-fluid temperatures above the tissue-damage threshold. Both systems can be used safely, provided the manufacturer instructions are followed and the irrigation system is effective.
II (prospective randomized trial).
Dermal burn: An unusual complication of radio frequency probe in shoulder arthroscopy
2017, Journal of Arthroscopy and Joint Surgery
Radiofrequency ablation probes have gained popularity in arthroscopic surgeries. We report an unusual complication associated with prolonged radiofrequency use in a shoulder arthroscopy case. A 55 year old male patient suffered a second degree burn around shoulder during rotator cuff repair. Long duration of radiofrequency probe use compounded by absence of suction outlet led to high temperature fluid coming in direct contact with the surrounding skin resulting in second degree burns around the shoulder region. Burns were managed conservatively, and went on to heal with hypopigmented scar at six month follow-up. Although a safe device, caution should be maintained while using radiofrequency probe and outflow should not be allowed to come in direct contact with the surrounding skin.
Temperature profile of radiofrequency probe application in wrist arthroscopy: Monopolar versus bipolar
2013, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
In our study the mean tissue temperature increased with the duration of the RFE application, and there was a significant difference between the bipolar and monopolar RFE systems concerning the heat expansion, which could be explained by the different functions of bipolar and monopolar systems. Similar results concerning the difference in the monopolar and bipolar systems had been achieved by former studies, whereas Edwards et al.5 found a significantly lower temperature for the monopolar system compared with the bipolar system. On the other hand, we had a higher peak temperature for the monopolar system than that for the bipolar system without irrigation, but it was not statistically significant.
The purpose of this study was to investigate the changes in temperature during wrist arthroscopy comparing monopolar and bipolar radiofrequency energy (RFE).
A standard wrist arthroscopy was performed on 14 arms of 7 cadavers without irrigation or with continuous irrigation with 0.9% saline solution and gravity-assisted outflow through an 18-gauge needle. We treated 7 wrists with a bipolar device (VAPR II with 2.3-mm side effect electrodes; DePuy Mitek, Westwood, MA) and 7 wrists with a monopolar device (OPES Ablator for small joints, 45°; Arthrex, Naples, FL). The temperature was recorded simultaneously from 7 predefined anatomic landmarks.
We observed an increase in the temperature corresponding to the time of energy application. The highest measured peak temperatures were 52°C (monopolar) and 49.5°C (bipolar) without irrigation. Continuous irrigation led to a significant reduction in the temperature at the site of the energy application. The mean temperature decreased by 7°C for the monopolar system and 5°C for the bipolar system when irrigation was used. For both radiofrequency devices, we found a decrease in the temperature proportional to the distance of the sensors to the radiofrequency probe.
Monopolar and bipolar RFE can be safely used in wrist arthroscopy if a continuous irrigation system is applied and the energy impulse does not exceed 5 to 10 seconds. However, it should be used with great care to avoid local heat damage especially at the cartilage.
This basic science study was performed to gain data concerning the temperature in wrist arthroscopy and to broaden the knowledge about the risks when using RFE. Furthermore, we sought to control side effects of RFE by finding the best applied form of RFE regarding duration and pulsation (monopolar/bipolar).

View all citing articles on Scopus

^*: Supported by Oratec Interventions, Inc., Menlo Park, California.

^**: Address correspondence and reprint requests to Mark D. Markel, D.V.M., Ph.D., Comparative Orthopaedic Research Laboratory, Department of Medical Sciences, School of Veterinary Medicine, 2015 Linden Dr West, University of Wisconsin-Madison, Madison, WI 53706-1102, U.S.A. E-mail: [email protected]

View full text

Original ArticlesThermometric determination of cartilage matrix temperatures during thermal chondroplasty: Comparison of bipolar and monopolar radiofrequency devices*,**

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Prosthet Dent

Injury

Brain Res

Radiofrequency energy-induced heating of bovine articular cartilage using a bipolar radiofrequency electrode

Am J Sports Med

Matrix assessment of the articular cartilage surface after chondroplasty with the holmium:YAG laser

Am J Sports Med

Quantification of laser-induced cartilage injury by confocal microscopy in an ex vivo model

J Bone Joint Surg Am

Thermal chondroplasty with radiofrequency energy: An in vitro comparison of bipolar and monopolar radiofrequency devices

Am J Sports Med

Thermal chondroplasty of chondromalacic human cartilage: An ex vivo comparison of bipolar and monopolar radiofrequency devices

Am J Sports Med

Use of adverse conditions to stimulate a cellular stress response by equine articular chondrocytes

Am J Vet Res

Heat Shock-induced necrosis and apoptosis in osteoblasts

J Orthop Res

Effects of temperature on phagocytosis of human and calf polymorphonuclear leukocytes

Artif Organs

Effects of heat on fragility and morphology of human and calf erythrocytes

J Invest Surg

Original Articles
Thermometric determination of cartilage matrix temperatures during thermal chondroplasty: Comparison of bipolar and monopolar radiofrequency devices*,**