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COMPARISON OF THE EFFECTS OF RADIOFREQUENCY ABLATION AND MECHANICAL SHAVING ON TENDON, USING HISTOLOGICAL AND ULTRASTRUCTURAL ANALYSIS

Department of Musculoskeletal Surgery, Imperial College, 7th Floor East, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF

The purpose of this study was to determine and compare the effects of radiofrequency ablation and mechanical shaving on tendon using histological and ultrastructural techniques. A single cut using a scalpel blade was used to create a standardised reproducible lesion in 12 freshly harvested ovine infraspinatus tendons. Each lesion was then subjected to either bipolar radiofrequency ablation or mechanical shaving. Specimens were either fixed in formalin and processed for light microscopy or fixed in glutaraldehyde and processed for transmission electron microscopy. Samples of normal and untreated cut tendon were analysed as suitable controls. The radiofrequency treated samples showed an area of coagulative necrosis with an average diameter of 2mm around the lesion. Conversely, the shaved samples showed viable cells up to the edges of the lesion. These findings were supported by ultrastructural appearances, which showed preservation of tendon architecture in shaved samples and widespread denaturation of the tendon matrix with loss of fibrillar structure in the radiofrequency treated samples. Radio-frequency electrical energy and mechanical shaving are often used for resection of soft tissues during arthroscopic reconstructive procedures. The effects of these techniques on tendon are not yet clearly understood. The results of this study indicate that thermal resection of tendon causes an immediate additional 2mm area of tissue necrosis which is not present after mechanical shaving. These findings may have implications for the success of arthroscopic debridement and tendon repair procedures.

Correspondence should be addressed to Dr Carlos Wigderowitz, Honorary Secretary of BORS, Division of Surgery & Oncology, Section of Orthopaedic & Trauma Surgery, Ninewells Hospital & Medical School Tort Centre, Dundee, DD1 9SY.