Comparison between 2 types of radiofrequency ablation systems in arthroscopic rotator cuff repair: a randomized controlled trial

BACKGROUND: Radiofrequency ablation is commonly used in arthroscopic rotator cuff repair (RCR). New technology devices incorporating a plasma bubble may generate lower intra-articular temperatures and be more efficient. PURPOSE: To compare a plasma ablation device with a standard ablation device in arthroscopic RCR to determine which system is superior in terms of intra-articular heat generation and diathermy efficiency. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: This was a single-center randomized controlled trial. The inclusion criteria were adult patients undergoing primary RCR. Patients were randomized preoperatively to the standard ablation group (n = 20) or plasma ablation group (n = 20). A thermometer was inserted into the shoulder joint during surgery, and the temperature, surgery, and diathermy times of radiofrequency ablation were measured continually. RESULTS: No significant differences were found between the standard ablation group and plasma ablation group for maximum temperature (38.20°C and 39.38°C, respectively; P = .433), mean temperature (31.66°C and 30.64°C, respectively; P = .757), minimum temperature (21.83°C and 23.45°C, respectively; P = .584), and baseline temperature (28.49°C and 29.94°C, respectively; P = .379). Similarly, no significant differences were found for surgery time (74 and 75 minutes, respectively; P = .866) and diathermy time (10 minutes for both; P = .678). Seven patients registered transient high temperatures greater than 45°C. CONCLUSION: There was no difference between plasma ablation and standard ablation in terms of intra-articular temperature in the joint and diathermy efficiency. Transient high intra-articular temperatures occurred in both groups

In vivo arthroscopic temperatures: a comparison between 2 types of radiofrequency ablation systems in arthroscopic anterior cruciate ligament reconstruction—a randomized controlled trial

Purpose: To compare a plasma ablation device with a standard ablation device in anterior cruciate ligament (ACL) reconstruction to determine which system is superior in terms of intra-articular heat generation and diathermy efficiency. Methods: This was a prospective, randomized controlled trial. The inclusion criteria were adult patients undergoing primary ACL reconstruction. Patients were randomized preoperatively to the standard ablation group or the plasma ablation group. A thermometer was inserted into the inferior suprapatellar pouch, and the temperature, time, and duration of radiofrequency ablation were measured continually. Results: No significant differences were found between the standard ablation system and the plasma ablation system for maximum temperature (29.77°C and 29.34°C, respectively; P =.95), mean temperature (26.16°C and 26.99°C, respectively; P =.44), minimum temperature (22.66°C and 23.94°C, respectively; P =.54), and baseline temperature (26.80°C and 27.93°C, respectively; P =.35). Similarly, no significant differences were found for operative time (82.90 minutes and 80.50 minutes, respectively; P =.72) and mean diathermy activation times (2.6 minutes for both systems; P =.90). The between-system coefficient of variation for the measured parameters ranged from 0.12% to 3.69%. No intra-articular readings above the temperature likely to damage chondrocytes were recorded. The mean irrigation fluid temperature had a significant correlation with the maximum temperature reached during the procedure (Spearman rank correlation, r = 0.87; P < .01). Conclusions: No difference in temperature was observed between the standard ablation and plasma ablation probes during ACL reconstruction. Temperatures did not exceed critical temperatures associated with chondrocyte death. Level of Evidence Level I, randomized controlled trial

The quadriceps active ratio: a dynamic MRI-based assessment of patellar height

Introduction: Patella alta (PA) is one of the primary correctable risk factors for patellofemoral instability (PFI). Both an accurate diagnosis of PA and a clinically relevant target for correction are necessary for optimal treatment. An ideal test for PA should relate the position of the patella to the femur rather than tibia, should do so with the quadriceps contracted and the patellar tendon under tension and should have good sensitivity and specificity. None of the currently used radiographic tests PA meet these criteria, most of which are based on the position of the patella relative to the tibia with diagnostic cutoffs based on 2 standard deviations from the mean rather than optimal sensitivity and specificity. The authors describe the quadriceps active ratio (Q+R), an MRI-based assessment of PA based on patellofemoral contact under quadriceps activated with a cutoff based on optimal sensitivity a specificity for PFI. Material–methods: Ninety-four participants investigated for knee pain or instability with a clinically indicated MRI were recruited. Routine MRI sequences were obtained, with the addition of a quadriceps contracted sagittal T1-weighted sequence. Participants presenting with PFI were identified. Those with trochlear dysplasia were identified and excluded from analysis so that patellar height could be assessed against PFI without being confounded by trochlear dysplasia. Q+R and patellotrochlear index (PTI) were calculated from the remaining 78 scans by 3 consultant orthopaedic surgeons at three time points. In 54 of these cases, a lateral radiograph was available from which the Insall-Salvati, modified Insall-Salvati, Caton-Deschamps and Blackburn-Peel ratios were also calculated. Intra- and inter-observer reliability was assessed for the Q+R. A cutoff value for the Q+R based on optimal sensitivity and specificity for the diagnosis of PFI was calculated from receiver-operator characteristic (ROC) curves and compared to the PTI. The cutoff for the Q+R was compared for sensitivity and specificity for the diagnosis of PFI against the radiographic ratios. Results: The Q+R had satisfactory or better ICC values across time points and surgeons. The Q+R was superior to the PTI on area under curve ROC analysis (0.76 vs 0.74). A cutoff value of 0.12 for the Q+R gave sensitivity of 79% and specificity of 55% for the diagnosis of PFI. The radiographic indices were generally insensitive for this diagnosis of PFI with sensitivities ranging from 0-66%. Conclusion: The Q+R is a reliable diagnostic test for patellar height assessment, showing good intra- and inter-rater consistency, and greater diagnostic accuracy than the PTI. A Q+R value of 0.12 is a good test for clinically significant PA. Of the radiographic indices, the Insall-Salvati ratio had the best diagnostic accuracy