Is there a role for radiofrequency-based ablation in the treatment of chondral lesions?

This roundtable panel was convened to exchange the personal experiences of individual clinicians who have used radiofrequency (RF)-based technology as an integral component in their treatment of chondral injuries. Roundtable participants suggested that an RF-based approach for performing chondral débridement may provide benefits over the mechanical shaver when used in the appropriately selected patient. Participants emphasized the importance of first carefully considering what one is trying to accomplish, and then selecting the best modality available to complete the task. Radiofrequency-based débridement has been shown to create a smoother treatment surface than mechanical means do. In addition, RF-based devices allow easier arthroscopic access. Since the goal of chondral débridement is to remove fibrillated or delaminated tissue, participants suggested that this technology is used optimally in a primarily ablative, or tissue-removal, mode in order to achieve desired effects. In addition, the panel members stressed that when considering RF-based devices for treating chondral lesions, it is important to select patients appropriately and limit treatment to mild- and moderate-grade chondral lesions. Panel members agreed that RF-based devices can be used successfully in conjunction with mechanical shavers, where the shaver is used to remove the major flaps, delaminations, and fibrillated tissue, while the RF-based device is used to finish the procedure to leave a clean, even chondral edge and smooth treatment surface. The participants also acknowledged that RF ablation is not a panacea for the treatment of cartilage injuries. It is merely one option in a comprehensive approach to the surgical management of chondral damage.