Cetik Ozgur, Cift Hakan, Comert Baris, Cirpar Meric
Department of Orthopedics and Traumatology, School of Medicine, Kirikkale University, Anabilim Dali, Kirikkale 71100, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2009 Jan;17(1):24-9. doi: 10.1007/s00167-008-0604-0. Epub 2008 Aug 29.
Radiofrequency (RF) energy can be used for treatment of intraarticular pathologies in knee joint. RF energy was found to be superior to mechanical techniques in smoothening the articular surface (chondroplasty), shortening the operation time and reducing the blood loss. As RF produces thermal energy it has been reported to be responsible for the postoperative osteonecrosis however, there is no clinical evidence in the literature supporting that RF causes osteonecrosis. The current study searches for an answer whether surgical arthroscopic modalities using RF energy causes osteonecrosis. We hypothesize in the presented study that chondroplasty with RF has no effect on increasing the incidence of osteonecrosis in knee joint. In a prospective clinical trial, arthroscopic chondroplasty was performed in 50 patients with degenerative changes of the articular cartilage, stage II and III according to Outerbridge. To be included in the study, the patients had to meet the following criteria: (1) Preoperative MRI and plain film radiographs showing no evidence of osteonecrosis. (2) Patients had to be symptomatic for at least 6 weeks before the preoperative MRI. (3) Arthroscopically confirmed stage II or III. Preoperative MRI was taken in all patients. For chondral lesions bipolar RF energy system (VAPR-DePuy Mitek, Norwood, USA) was used. The patients were examined at the end of the sixth month and we performed MRI. Fifty patients with an average of age 45.54 (between 18 and 64) (SD, 10.63). During arthroscopy, together with chondropathy 22 patients pure medial meniscus tears, 7 patients medial and lateral meniscus tears, 7 patients pure lateral meniscus tears, 2 patients medial plica, and 3 patients synovial hypertrophy were detected. Among all 50 patients, osteonecrosis were detected at only 2 (4%) in the postoperative period. Until now it was not clear that RF energy causes osteonecrosis; however, according to this study if proper method is used, bipolar RF energy used for arthroscopic chondroplasty does not causes subchondral osteonecrosis.
射频（RF）能量可用于治疗膝关节内的病变。研究发现，在使关节表面光滑（软骨成形术）、缩短手术时间和减少失血方面，射频能量优于机械技术。由于射频会产生热能，据报道它是术后骨坏死的原因，然而，文献中没有临床证据支持射频会导致骨坏死。本研究旨在探寻使用射频能量的手术关节镜治疗方式是否会导致骨坏死。在本研究中，我们假设射频软骨成形术对增加膝关节骨坏死的发生率没有影响。在一项前瞻性临床试验中，对50例根据Outerbridge分级处于II期和III期的关节软骨退行性变患者进行了关节镜软骨成形术。要纳入该研究，患者必须符合以下标准：（1）术前MRI和平片X线检查未显示骨坏死迹象。（2）患者在术前MRI检查前至少有6周的症状。（3）关节镜检查确诊为II期或III期。所有患者均进行了术前MRI检查。对于软骨损伤，使用了双极射频能量系统（VAPR - 美国德普伊米泰克公司，诺伍德）。在第六个月末对患者进行了检查并进行了MRI检查。50例患者的平均年龄为45.54岁（18至64岁之间）（标准差为10.63）。在关节镜检查期间，除了软骨病外，还检测到22例单纯内侧半月板撕裂、7例内侧和外侧半月板撕裂、7例单纯外侧半月板撕裂、2例内侧皱襞和3例滑膜增生。在所有50例患者中，术后仅检测到2例（4%）骨坏死。到目前为止，尚不清楚射频能量是否会导致骨坏死；然而，根据本研究，如果使用正确的方法，用于关节镜软骨成形术的双极射频能量不会导致软骨下骨坏死。
