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Arthroscopic Evaluation of Radiofrequency Chondroplasty of the Knee

Ilya Voloshin, MD^,*, Kenneth R. Morse, MD, C. Dain Allred, MD, Scott A. Bissell, MD, Michael D. Maloney, MD and Kenneth E. DeHaven, MD

From the Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, and SportsMedicine Partners, Orthopedics & Rehabilitation Therapy, South Windsor, Connecticut

^* Address correspondence to Ilya Voloshin, MD, Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 (e-mail: Ilya_voloshin{at}urmc.rochester.edu).

Background: Considerable debate exists over the use of radiofrequency-based chondroplasty to treat partial-thickness chondral defects of the knee. This study used second-look arthroscopy to evaluate cartilage defects previously treated with bipolar radiofrequency–based chondroplasty.

Hypothesis: Partial-thickness articular cartilage lesions treated with bipolar radiofrequency–based chondroplasty will show no progressive deterioration.

Study Design: Case series; Level of evidence, 4.

Methods: One hundred ninety-three consecutive patients underwent bipolar radiofrequency–based chondroplasty over 38 months; 15 (25 defects treated with bipolar radiofrequency–based chondroplasty) underwent repeat arthroscopy for recurrent or new injuries. Time from the initial to repeat arthroscopy ranged from 0.7 to 32.7 months. At both procedures, the location, size, grade, and stability of lesions were evaluated, recorded, and photographed arthroscopically.

Results: At the initial procedure, 25 lesions treated using bipolar radiofrequency–based chondroplasty ranged from 9 to 625 mm² (mean, 170.2 ± 131.2 mm²; median, 120 mm²); at second look, lesion size was 9 to 300 mm² (mean, 107.7 ± 106.7 mm²; median, 100 mm²). At second look, 3 (12%) demonstrated unstable borders with damage in the surrounding cartilage that appeared to be progressive. Eight (32%) lesions were unchanged in size. Eight (32%) demonstrated partial filling with stable repair tissue, and 6 (24%) demonstrated complete filling with stable repair tissue. Lesions in the tibiofemoral compartments showed better response to radiofrequency chondroplasty than did those within the patellofemoral joint (P < .05).

Conclusion: Only 3 of 25 lesions demonstrated progression. More than 50% showed partial or complete filling of the defect. Bipolar radiofrequency chondroplasty is an effective way to treat partial-thickness cartilage lesions; however, long-term effects of this treatment on cartilage remain unknown.

Key Words: radiofrequency • chondroplasty • arthroscopy • osteonecrosis