McKeon B, Baltz MS, Curtis A, Scheller A
J Shoulder Elbow Surgery. 2007 Jan-Feb; 16(1):107-11
Thermal treatment of tissues in shoulder surgery is not new. Laser has been used in the past to successfully treat glenohumeral instability. High costs, significant collateral thermal tissue damage to axillary nerve and capsule has pushed this form of treatment into the back seat. Some case reports have raised concerns about possible chondrolysis. Similar to laser there is a natural concern about possible thermal side effects from radiofrequency (RF) application in the treatment of shoulder capsulorrhaphy. The RF devices use electromagnetic energy and are capable of using energy to shrink, coagulate and ablate tissues. The authors have devised a study, to assess the thermal effects of RF during thermal capsulorrhaphy and subacromial decompression. 3 most common commercially available RF devices were chosen.
Fifteen fresh frozen cadaveric shoulders were randomly divided into 3 groups. 4 fluoroptic mini-thermometer probes were positioned at specific anatomical locations as follows: at the inflow saline solution bag, 3mm from the RF tip, the central glenoid region, and the inferior glenohumeral ligament in thermal capsulorrhaphy and the saline solution inflow bag, anterior subacromial space and the posterior subacromial space in subacromial decompressions. Standard arthroscopic portals were used for both the procedures. Temperature count data were recorded and stored every second in degrees Celsius from all four-temperature probes.
Degenerative articular cartilage surface defects require a temperature of 56.5 degree centigrade to display significant articular change. Studies have shown viability of chondrocytes is at risk with temperatures in the range of 55 degree centigrade. The fluid temperatures recorded with all three RF devices were much lower compared to in vivo temperatures required for tissue shrinkage or cartilage injury. Continuous arthroscopic fluid flow keeps the heat energy under control and dissipated.
