Mechanical debridement versus radiofrequency in knee chondroplasty with concomitant medial meniscectomy: 10-year results from a randomized controlled study

We compared the effectiveness of mechanical debridement (MD) and bipolar radiofrequency chondroplasty (RF) with regard to clinical outcome, rate of revision, and progression of knee osteoarthritis.

Sixty patients with MRI-detected grade III cartilage lesions on the medial femoral condyle were considered for the study. For MD (group 1; n = 30), each lesion was debrided using a mechanical shaver. For RF (group 2; n = 30), each lesion was smoothed using a temperature-controlled RF probe set at 50 °C.

The 10-year follow-up was available for 47 patients (78.3 %). Sixty per cent of group 1 (n = 18) underwent revision during the follow-up period. In contrast, the revision rate in group 2 was 23.3 % (n = 7; p = 0.061). The mean survival was 94.1 months (95 % CI 77.1-111.3) and 62.5 months (95 % CI 45.9-79.2) for group 2 and group 1, respectively. Patients who did not require revision (group 1, n = 9; group 2, n = 13) were assessed before surgery and 1, 4, and 10 years after surgery using the knee injury and osteoarthritis outcome score (KOOS). At follow-up, the KOOS was higher for group 2 than group 1. At the time of surgery, no patient showed any radiological signs of osteoarthritis. The width of the medial joint was 5.4 mm (95 % CI 4.3-6.5) and 5.6 mm (95 % CI 4.9-6.3) in the MD and RF groups, respectively (n.s.). During the follow-up period, the joint space width narrowed continuously in both groups (p < 0.001), but more rapidly in the group 1 (n.s).

Compared to conventional MD, 50° RF treatment appears to be a superior method based on short- and medium-term clinical outcomes and the progression of knee osteoarthritis. Clear predictors for the indications of different cartilage treatments and more randomized clinical trials are needed.

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