[Basic principles of radiosurgical systems and their applications in arthroscopy]

Area of Science:

• Orthopedics
• Surgical Technology
• Biomedical Engineering

Background:

• Electrosurgical devices, particularly bipolar, high-frequency systems, are now common in arthroscopic surgery.
• Their widespread adoption is driven by device miniaturization and cost-effectiveness.
• These devices utilize a local plasma field for tissue disintegration, offering advantages over monopolar and laser systems.

Purpose of the Study:

• To investigate the mid- and long-term biological effects of electrosurgery on arthroscopic surgical sites.
• To address the discrepancy between the broad clinical application and the limited understanding of electrosurgery's biological impact.
• To evaluate the safety and efficacy of electrosurgery in procedures like chondroplasty and capsular/ligamental shrinkage.

Main Methods:

• Review of existing clinical and experimental studies on electrosurgery in arthroscopy.
• Analysis of histological findings, including cell viability (chondrocytes, fibroblasts) at varying depths post-treatment.
• Assessment of reported outcomes for chondroplasty and capsular/ligamental shrinkage procedures.

Main Results:

• Studies indicate significant chondrocyte and fibroblast death within millimeters of the treatment zone in articular cartilage and joint capsules.
• There is conflicting evidence regarding the clinical significance of these cellular changes, with some studies suggesting potential harm.
• Lack of reliable feedback systems for critical parameters like temperature increase poses a challenge.

Conclusions:

• The long-term biological consequences of electrosurgery in arthroscopy are not fully understood, leading to debate about its safety.
• Concerns exist regarding the viability of essential cells in joint tissues following electrosurgical intervention.
• Further research is required to establish the safety profile of these devices, and their use necessitates experienced surgeons.