The effects of radiofrequency on cartilage: A systematic review of preclinical evidence in animals and humans.

PURPOSE

Radiofrequency works by applying continuous waveforms which ablate the surface of the cartilage. Despite its utility, the limits and possible risks of this technology have not been thoroughly investigated in the literature. This review aims to systematically summarise the most recent studies regarding the effects of the various radiofrequency on cartilage and compare the side effects they may bring.

METHODS

A search following the PRISMA guidelines was conducted on scientific databases: Web of Science, Embase CINAHL, ProQuest and Medline from May 2021 to January 2025. The databases were searched from their inception to September 2023. Only articles in English were included. In vivo, ex vivo, cadaveric, and in vitro studies were all included. To assess the risk of bias, Rob2 and ROBINS-I were used.

RESULTS

Twenty-eight studies were included in this systematic review. The level of evidence of the included studies ranged from level II to III. The most analysed specimen was human tissue, followed by swine, ovine, bovine, equine, canine and rabbit. Cartilage damage was reported in most of the articles. Monopolar radiofrequency was considered safer than bipolar radiofrequency. However, controversial results were found on the superiority of radiofrequency energy to mechanical debridement.

CONCLUSION

This review shows that there is not enough evidence to precisely identify the possible dangers or benefits that may come from the use of radiofrequency energy on cartilage. Therefore, the real risks of radiofrequency are not fully explored. Further research needs to include radiofrequency energy in the clinical and surgical environment.

LEVEL OF EVIDENCE

Level II, evidence from one or more well designs randomised control trials (RCT).