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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2016

01.10.2015 | Knee

Mechanical debridement versus radiofrequency in knee chondroplasty with concomitant medial meniscectomy: 10-year results from a randomized controlled study

verfasst von: Gunter Spahn, Gunther O. Hofmann, Lars Victor von Engelhardt

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 5/2016

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Abstract

Purpose

We compared the effectiveness of mechanical debridement (MD) and bipolar radiofrequency chondroplasty (RF) with regard to clinical outcome, rate of revision, and progression of knee osteoarthritis.

Methods

Sixty patients with MRI-detected grade III cartilage lesions on the medial femoral condyle were considered for the study. For MD (group 1; n = 30), each lesion was debrided using a mechanical shaver. For RF (group 2; n = 30), each lesion was smoothed using a temperature-controlled RF probe set at 50 °C.

Results

The 10-year follow-up was available for 47 patients (78.3 %). Sixty per cent of group 1 (n = 18) underwent revision during the follow-up period. In contrast, the revision rate in group 2 was 23.3 % (n = 7; p = 0.061). The mean survival was 94.1 months (95 % CI 77.1–111.3) and 62.5 months (95 % CI 45.9–79.2) for group 2 and group 1, respectively. Patients who did not require revision (group 1, n = 9; group 2, n = 13) were assessed before surgery and 1, 4, and 10 years after surgery using the knee injury and osteoarthritis outcome score (KOOS). At follow-up, the KOOS was higher for group 2 than group 1. At the time of surgery, no patient showed any radiological signs of osteoarthritis. The width of the medial joint was 5.4 mm (95 % CI 4.3–6.5) and 5.6 mm (95 % CI 4.9–6.3) in the MD and RF groups, respectively (n.s.). During the follow-up period, the joint space width narrowed continuously in both groups (p < 0.001), but more rapidly in the group 1 (n.s).

Conclusion

Compared to conventional MD, 50° RF treatment appears to be a superior method based on short- and medium-term clinical outcomes and the progression of knee osteoarthritis. Clear predictors for the indications of different cartilage treatments and more randomized clinical trials are needed.

Level of evidence

I.
Literatur
1.
Zurück zum Zitat Amiel D, Ball ST, Tasto JP (2004) Chondrocyte viability and metabolic activity after treatment of bovine articular cartilage with bipolar radiofrequency: an in vitro study. Arthroscopy 20:503–510CrossRefPubMed Amiel D, Ball ST, Tasto JP (2004) Chondrocyte viability and metabolic activity after treatment of bovine articular cartilage with bipolar radiofrequency: an in vitro study. Arthroscopy 20:503–510CrossRefPubMed
2.
Zurück zum Zitat Barber FA, Iwasko NG (2006) Treatment of grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe. Arthroscopy 22:1312–1317CrossRefPubMed Barber FA, Iwasko NG (2006) Treatment of grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe. Arthroscopy 22:1312–1317CrossRefPubMed
3.
Zurück zum Zitat Barber FA, Uribe JW, Weber SC (2002) Current applications for arthroscopic thermal surgery. Arthroscopy 18:40–50CrossRefPubMed Barber FA, Uribe JW, Weber SC (2002) Current applications for arthroscopic thermal surgery. Arthroscopy 18:40–50CrossRefPubMed
4.
Zurück zum Zitat Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl. 2):58–69PubMed Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl. 2):58–69PubMed
5.
Zurück zum Zitat Cetik O, Cift H, Comert B, Cirpar M (2009) Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series. Knee Surg Sports Traumatol Arthrosc 17:24–29CrossRefPubMed Cetik O, Cift H, Comert B, Cirpar M (2009) Risk of osteonecrosis of the femoral condyle after arthroscopic chondroplasty using radiofrequency: a prospective clinical series. Knee Surg Sports Traumatol Arthrosc 17:24–29CrossRefPubMed
6.
Zurück zum Zitat Cicuttini FM, Jones G, Forbes A, Wluka AE (2004) Rate of cartilage loss at two years predicts subsequent total knee arthroplasty: a prospective study. Ann Rheum Dis 63:1124–1127CrossRefPubMedPubMedCentral Cicuttini FM, Jones G, Forbes A, Wluka AE (2004) Rate of cartilage loss at two years predicts subsequent total knee arthroplasty: a prospective study. Ann Rheum Dis 63:1124–1127CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Edwards RB, Lu Y, Cole BJ, Muir P, Markel MD (2008) Comparison of radiofrequency treatment and mechanical debridement of fibrillated cartilage in an equine model. Vet Comp Orthop Traumatol 21:41–48PubMed Edwards RB, Lu Y, Cole BJ, Muir P, Markel MD (2008) Comparison of radiofrequency treatment and mechanical debridement of fibrillated cartilage in an equine model. Vet Comp Orthop Traumatol 21:41–48PubMed
8.
Zurück zum Zitat Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1000 knee arthroscopies. Arthroscopy 18:730–734CrossRefPubMed Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1000 knee arthroscopies. Arthroscopy 18:730–734CrossRefPubMed
9.
Zurück zum Zitat Horton D, Anderson S, Hope NG (2014) A review of current concepts in radiofrequency chondroplasty. ANZ J Surg 84:412–416CrossRefPubMed Horton D, Anderson S, Hope NG (2014) A review of current concepts in radiofrequency chondroplasty. ANZ J Surg 84:412–416CrossRefPubMed
10.
Zurück zum Zitat Howell SM (2010) The role of arthroscopy in treating osteoarthritis of the knee in the older patient. Orthopedics 33:652PubMed Howell SM (2010) The role of arthroscopy in treating osteoarthritis of the knee in the older patient. Orthopedics 33:652PubMed
11.
Zurück zum Zitat Kang RW, Gomoll AH, Nho SJ, Pylawka TK, Cole BJ (2008) Outcomes of mechanical debridement and radiofrequency ablation in the treatment of chondral defects: a prospective randomized study. J Knee Surg 21:116–121PubMed Kang RW, Gomoll AH, Nho SJ, Pylawka TK, Cole BJ (2008) Outcomes of mechanical debridement and radiofrequency ablation in the treatment of chondral defects: a prospective randomized study. J Knee Surg 21:116–121PubMed
12.
Zurück zum Zitat Kaplan L, Uribe JW (2000) The acute effects of radiofrequency energy in articular cartilage: an in vitro study. Arthroscopy 16:2–5CrossRefPubMed Kaplan L, Uribe JW (2000) The acute effects of radiofrequency energy in articular cartilage: an in vitro study. Arthroscopy 16:2–5CrossRefPubMed
13.
Zurück zum Zitat Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C (2008) Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev CD005118 Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C (2008) Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev CD005118
14.
Zurück zum Zitat Lu Y, Hayashi K, Hecht P, Fanton GS, Thabit G III, Cooley AJ, Edwards RB, Markel MD (2000) The effect of monopolar radiofrequency energy on partial-thickness defects of articular cartilage. Arthroscopy 16:527–536CrossRefPubMed Lu Y, Hayashi K, Hecht P, Fanton GS, Thabit G III, Cooley AJ, Edwards RB, Markel MD (2000) The effect of monopolar radiofrequency energy on partial-thickness defects of articular cartilage. Arthroscopy 16:527–536CrossRefPubMed
15.
Zurück zum Zitat Mitchell N, Shepard N (1987) Effect of patellar shaving in the rabbit. J Orthop Res 5:388–392CrossRefPubMed Mitchell N, Shepard N (1987) Effect of patellar shaving in the rabbit. J Orthop Res 5:388–392CrossRefPubMed
16.
Zurück zum Zitat Niemeyer P, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Behrens P, Bosch U, Erggelet C, Fickert S, Fritz J, Gebhard H, Gelse K, Gunther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Muller PE, Noth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Albrecht D (2013) Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU). Z Orthop Unfall 151:38–47PubMed Niemeyer P, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Behrens P, Bosch U, Erggelet C, Fickert S, Fritz J, Gebhard H, Gelse K, Gunther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Muller PE, Noth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Albrecht D (2013) Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU). Z Orthop Unfall 151:38–47PubMed
17.
Zurück zum Zitat Ogilvie-Harris DJ, Jackson RW (1984) The arthroscopic treatment of chondromalacia patellae. J Bone Joint Surg Br 66:660–665PubMed Ogilvie-Harris DJ, Jackson RW (1984) The arthroscopic treatment of chondromalacia patellae. J Bone Joint Surg Br 66:660–665PubMed
18.
Zurück zum Zitat Osti L, Papalia R, Del BA, Amato C, Denaro V, Maffulli N (2010) Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries. Knee Surg Sports Traumatol Arthrosc 18:1385–1390CrossRefPubMed Osti L, Papalia R, Del BA, Amato C, Denaro V, Maffulli N (2010) Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries. Knee Surg Sports Traumatol Arthrosc 18:1385–1390CrossRefPubMed
19.
Zurück zum Zitat Owens BD, Stickles BJ, Balikian P, Busconi BD (2002) Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy 18:151–155CrossRefPubMed Owens BD, Stickles BJ, Balikian P, Busconi BD (2002) Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy 18:151–155CrossRefPubMed
20.
Zurück zum Zitat Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefPubMed Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefPubMed
21.
Zurück zum Zitat Sgaglione NA, Miniaci A, Gillogly SD, Carter TR (2002) Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy 18:9–32CrossRefPubMed Sgaglione NA, Miniaci A, Gillogly SD, Carter TR (2002) Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy 18:9–32CrossRefPubMed
22.
Zurück zum Zitat Shellock FG, Shields CL Jr (2000) Radiofrequency energy-induced heating of bovine articular cartilage using a bipolar radiofrequency electrode. Am J Sports Med 28:720–724PubMed Shellock FG, Shields CL Jr (2000) Radiofrequency energy-induced heating of bovine articular cartilage using a bipolar radiofrequency electrode. Am J Sports Med 28:720–724PubMed
23.
Zurück zum Zitat Spahn G, Frober R, Linss W (2006) Treatment of chondral defects by hydro jet. Results of a preliminary scanning electron microscopic evaluation. Arch Orthop Trauma Surg 126:223–227CrossRefPubMed Spahn G, Frober R, Linss W (2006) Treatment of chondral defects by hydro jet. Results of a preliminary scanning electron microscopic evaluation. Arch Orthop Trauma Surg 126:223–227CrossRefPubMed
24.
Zurück zum Zitat Spahn G, Hofmann GO (2014) Focal cartilage defects within the medial knee compartment. predictors for osteoarthritis progression. Z Orthop Unfall 152:480–488CrossRefPubMed Spahn G, Hofmann GO (2014) Focal cartilage defects within the medial knee compartment. predictors for osteoarthritis progression. Z Orthop Unfall 152:480–488CrossRefPubMed
25.
Zurück zum Zitat Spahn G, Kahl E, Muckley T, Hofmann GO, Klinger HM (2008) Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study. Knee Surg Sports Traumatol Arthrosc 16:565–573CrossRefPubMed Spahn G, Kahl E, Muckley T, Hofmann GO, Klinger HM (2008) Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study. Knee Surg Sports Traumatol Arthrosc 16:565–573CrossRefPubMed
26.
Zurück zum Zitat Spahn G, Klinger HM, Harth P, Hofmann GO (2012) Cartilage regeneration after high tibial osteotomy. Results of an arthroscopic study. Z Orthop Unfall 150:272–279PubMed Spahn G, Klinger HM, Harth P, Hofmann GO (2012) Cartilage regeneration after high tibial osteotomy. Results of an arthroscopic study. Z Orthop Unfall 150:272–279PubMed
27.
Zurück zum Zitat Stein DT, Ricciardi CA, Viehe T (2002) The effectiveness of the use of electrocautery with chondroplasty in treating chondromalacic lesions: a randomized prospective study. Arthroscopy 18:190–193CrossRefPubMed Stein DT, Ricciardi CA, Viehe T (2002) The effectiveness of the use of electrocautery with chondroplasty in treating chondromalacic lesions: a randomized prospective study. Arthroscopy 18:190–193CrossRefPubMed
28.
Zurück zum Zitat Strobel M (1998) Manual of arthroscopic surgery. Springer, Berlin, Heidelberg Strobel M (1998) Manual of arthroscopic surgery. Springer, Berlin, Heidelberg
29.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed
30.
Zurück zum Zitat Turker M, Cetik O, Cirpar M, Durusoy S, Comert B (2015) Postarthroscopy osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 23:246–250CrossRefPubMed Turker M, Cetik O, Cirpar M, Durusoy S, Comert B (2015) Postarthroscopy osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 23:246–250CrossRefPubMed
31.
Zurück zum Zitat Turner AS, Tippett JW, Powers BE, Dewell RD, Mallinckrodt CH (1998) Radiofrequency (electrosurgical) ablation of articular cartilage: a study in sheep. Arthroscopy 14:585–591CrossRefPubMed Turner AS, Tippett JW, Powers BE, Dewell RD, Mallinckrodt CH (1998) Radiofrequency (electrosurgical) ablation of articular cartilage: a study in sheep. Arthroscopy 14:585–591CrossRefPubMed
32.
Zurück zum Zitat Voloshin I, DeHaven KE, Steadman JR (2005) Second-look arthroscopic observations after radiofrequency treatment of partial thickness articular cartilage defects in human knees: report of four cases. J Knee Surg 18:116–122CrossRefPubMed Voloshin I, DeHaven KE, Steadman JR (2005) Second-look arthroscopic observations after radiofrequency treatment of partial thickness articular cartilage defects in human knees: report of four cases. J Knee Surg 18:116–122CrossRefPubMed
33.
Zurück zum Zitat Voloshin I, Morse KR, Allred CD, Bissell SA, Maloney MD, DeHaven KE (2007) Arthroscopic evaluation of radiofrequency chondroplasty of the knee. Am J Sports Med 35:1702–1707CrossRefPubMed Voloshin I, Morse KR, Allred CD, Bissell SA, Maloney MD, DeHaven KE (2007) Arthroscopic evaluation of radiofrequency chondroplasty of the knee. Am J Sports Med 35:1702–1707CrossRefPubMed
34.
Zurück zum Zitat Wang N, Liu YJ, Xue J, Li HF, He W, Wang JL (2012) Effects of radiofrequency energy on porcine articular cartilage: higher-power settings in ablation mode show lower thermal radiation injury. Knee Surg Sports Traumatol Arthrosc 20:1901–1906CrossRefPubMed Wang N, Liu YJ, Xue J, Li HF, He W, Wang JL (2012) Effects of radiofrequency energy on porcine articular cartilage: higher-power settings in ablation mode show lower thermal radiation injury. Knee Surg Sports Traumatol Arthrosc 20:1901–1906CrossRefPubMed
35.
Zurück zum Zitat Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 14:177–182CrossRefPubMed Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 14:177–182CrossRefPubMed
Metadaten
Titel
Mechanical debridement versus radiofrequency in knee chondroplasty with concomitant medial meniscectomy: 10-year results from a randomized controlled study
verfasst von
Gunter Spahn
Gunther O. Hofmann
Lars Victor von Engelhardt
Publikationsdatum
01.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 5/2016
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3810-6

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