Piper Danielle, Taylor Clare, Howells Nick, Murray James, Porteous Andrew, Robinson James R
Trauma and Orthopaedics, Avon Orthopaedic Centre, Bristol, GBR.
Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, GBR.
Cureus. 2021 Jan 22;13(1):e12864. doi: 10.7759/cureus.12864.
Introduction Although stabilisation of knee cartilage lesions (chondroplasty) may be performed with an arthroscopic shaver, more recently, radiofrequency (RF) ablation has gained in popularity. However, their remain some concerns about the avoidance of thermal injury, chondrolysis, and osteonecrosis with the use of RF devices. Methods We reviewed the outcomes of 85 knee chondroplasties performed with a new RF ablation wand designed for knee chondroplasty. Lesion details and Chondropaenia Severity Score (CSS) were recorded for each patient. We evaluated the occurrence of adverse outcomes, post-operative complications, and the need for further surgery. Post-operative outcomes scores (Oxford Knee Score [OKS], Knee injury and Osteoarthritis Outcome Score [KOOS], and International Knee Documentation Committee [IKDC] subjective knee outcome) were recorded at a minimum of one-year follow-up. Results At the final mean follow-up of 27.5 months (range: 12-46.6 months), 12 (14%) knees had undergone or were listed for further surgery. Four patients had corticosteroid injections for ongoing pain at a median 7.5 months (range: 5-20 months) post-operatively. There were no observed re-operations considered to be caused by complications related to thermal injury. Of the six patients listed for or undergoing knee arthroplasty, five (83%) had grade 4 lesions found at the arthroscopic chondroplasty. A negative correlation was noted between CCS, and post-operative IKDC subjective score (R=-0.35), KOOS Sports (R=-0.39), and KOOS QoL (R=-0.36). Conclusions We found that RF chondroplasty appeared safe, and there were no concerns with regard to thermal injury. Functional outcome appeared to be related to the quality of chondral and meniscal tissue throughout all knee compartments, with better results for isolated grade 2 and 3 cartilage lesions.
引言 尽管膝关节软骨损伤的稳定化处理（软骨成形术）可以通过关节镜刨削器来进行，但最近，射频（RF）消融术越来越受欢迎。然而，对于使用射频设备时如何避免热损伤、软骨溶解和骨坏死，仍然存在一些担忧。方法 我们回顾了使用一种专为膝关节软骨成形术设计的新型射频消融棒进行的85例膝关节软骨成形术的结果。记录了每位患者的损伤细节和软骨减少严重程度评分（CSS）。我们评估了不良后果、术后并发症的发生情况以及进一步手术的必要性。在至少一年的随访中记录术后结果评分（牛津膝关节评分[OKS]、膝关节损伤和骨关节炎结果评分[KOOS]以及国际膝关节文献委员会[IKDC]主观膝关节结果）。结果 在最终平均随访27.5个月（范围：12 - 46.6个月）时，12例（14%）膝关节已经接受或被列入进一步手术名单。4例患者在术后中位时间7.5个月（范围：5 - 20个月）因持续疼痛接受了皮质类固醇注射。没有观察到被认为是由热损伤相关并发症引起的再次手术。在被列入或正在接受膝关节置换术的6例患者中，5例（83%）在关节镜软骨成形术中发现有4级损伤。CSS与术后IKDC主观评分（R = -0.35）、KOOS运动功能评分（R = -0.39）和KOOS生活质量评分（R = -0.36）之间存在负相关。结论 我们发现射频软骨成形术似乎是安全的，并且不存在热损伤方面的担忧。功能结果似乎与所有膝关节腔室的软骨和半月板组织质量有关，孤立的2级和3级软骨损伤的结果更好。
