In Vivo Arthroscopic Temperatures: Comparison between Two Types of Radiofrequency Ablation Systems

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Radiofrequency ablation is a commonly utilized tool in arthroscopic orthopaedic surgery primarily in joints such as shoulders and knees. It allows accurate debridement of soft tissues and control of bleeding. Use of radiofrequency ablation wands produces heat either directly or as a by-product. Studies have shown that if these temperatures exceed a certain threshold, (commonly known to be 45 degrees Celcius), the risk of injury to surrounding tissues within the joint is increases. We will be comparing two types of radiofrequency ablation systems that are very widely used today in arthroscopic surgery. One system, such as the Striker SERFAS Energy probe, uses radiofrequency energy to generate heat at the tip of the instrument. This heat is used to ablate or remove unwanted or damaged tissues and may also be used to coagulate vessels to control bleeding. The other system, such as that used in the Arthrocare RF wands, uses 'coblation' technology. This technology differs in that it uses radiofrequency energy to produce a controlled non-heat driven process where it excites electrodes within the surrounding saline solution to create a charged plasma gas that breaks up molecular bonds within tissue. Heat in this system, is produced as a by-product, and as claimed by its manufacturers, at much lower temperatures. In this study we will be comparing the temperatures established in arthroscopic surgery to determine the risk of injury to surrounding tissues using both these two systems. We will be recruiting 80 patients undergoing arthroscopic knee or shoulder surgery for a variety of conditions. The patients will be randomised to the ablation system and temperatures will be continuously monitored and recorded using an independent digital temperature probe. The probe will be placed in the same location within the joint in all patients through a small key-hole incision. The duration of surgery will also be recorded. Many variable can affect the fluid temperatures and these incluced, baseline infused fluid temperature, flow rate, and number of ports. We will not be regulating these variables in order to create a more natural clinical scenario which will in turn produce results that are more relevant to the common orthopaedic surgeon. Results will be analysed to determine the average and maximum temperatures reached in both systems, and in different types of surgeries (e.g. rotator cuff repair, sub-acromial decompression and acromioplasty, and stabilisation in shoulders, and ACL reconstruction in knees). Statistical analyses will be used to determine if there are any statistically significant differences in results using the two types of ablation systems and whether in fact using the Arthrocare charged plasma 'coblation' process will produce lower and potentially safer temperatures.

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