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Radiofrequency showed superior 10-year results vs shaving to treat grade 3 cartilage lesions
Multicenter trials are needed to evaluate long-term results of radiofrequency for deep cartilage defects, according to a presenter.
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In the treatment of grade 3 knee cartilage lesions, radiofrequency yielded better outcomes than mechanical debridement based on results presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress.
“Radiofrequency (RF) seems to have advantages compared with mechanical debridement of grade 3 defects, in short- and middle-term results,” Gunter O. Spahn, MD, of Center of Trauma and Orthopaedic Surgery and Jena University Hospital in Germany, said at the meeting. However, more multicenter studies are needed to assess the long-term results of this procedure, Spahn noted.
There are several arthroscopic treatment options available for this type of injury, according to Spahn.
“You can perform nothing,” he said. “You can perform mechanical debridement [or] you can perform, of course, other bioregenerative techniques.”
Debridement options
Mechanical debridement or shaving is the most common treatment method for International Cartilage Repair Society grade 3 cartilage lesions, he said.
“But, in our studies, we have shown this is an aggressive procedure and that is my personal opinion,” Spahn said. “This method should be performed carefully.”
Spahn and colleagues conducted a randomized, controlled study that compared the clinical outcomes of mechanical debridement and controlled 50° bipolar RF chondroplasty. The trial included 60 patients, with 30 patients per group. Both groups were comparable at baseline.
10-year follow-up
Ten-year follow-up was available for 47 patients, according to Spahn. Patients in both groups underwent revision surgery. There were 18 patients (60%) in the mechanical debridement group and seven patients (23.3%) in the RF group. There was a shorter time to revision surgery in the mechanical debridement group than in the RF group. Mean survival for the mechanical debridement patients was 62.5 months compared with 94.1 months for the RF patients.
Spahn and colleagues used the KOOS score to assess patients who did not require revision at different time points. The score was used before surgery and at 1 year, 4 years and 10 years postoperatively. No patients showed radiological signs of osteoarthritis at the time of cartilage treatment surgery.
At 1 year postoperatively, both groups had improved significantly, but there were some areas in which RF demonstrated an advantage, according to Spahn. For instance, the RF group reported higher subjective outcome scores, he said.
Medial joint space width was similar in both groups at 5.4 mm in the mechanical debridement group and 5.6 mm in the RF group. In both groups, the joint space narrowed continuously during the course of follow-up, although it proceeded more rapidly in the mechanical debridement group, the results showed.
Mechanical debridement “is a raw instrument,” Spahn said. “You have no chance to control it intraoperatively.
In contrast to that, RF offers greater control with a less invasive method “that may indeed produce better results,” Spahn said. – by Colleen Owens
- References:
- Spahn G, et al. Abstract #FP-28-2021. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.
- Spahn G, et al. Knee Surg Sports Traumatol Arthrosc. 2016;doi:10.1007/s00167-015-3810-6.
- For more information:
- Gunter O. Spahn, MD, can be reached at the Center of Trauma and Orthopaedic Surgery and Jena University Hospital, Sophienstr. 16, 99817, Eisenach, Germany; email: spahn@pk-eisenach.de.
Disclosure: Spahn reports no relevant financial disclosures.