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Document Title: Kondo-AJARS-Apr05.shtml
Article Title: The effect of electrothermal shrinkage on the biomechanical properties of the anterior cruciate ligament: An experimental study
Authors: Eiji Kondo, Kazunori Yasuda, Nobuto Kitamura, Toshiharu Kudoh, Akio Minami, and Harukazu Tohyama
Publication: Arthroscopy: The Journal of Arthroscopic & Related Surgery
Date: April 2005
Volume 21, Issue 4, April 2005, Pages 448-456
Keywords: thermal shrinkage, ACL partial tearing, biomechanics, radiofrequency, collagen fibre failure, heating, tissue destruction, damage, histology.
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Comments: This razor-sharp study makes it abundantly and unequivocally clear that thermal shrinkage (as done by radiofrequency, laser, or other means) has no place in the treatment of ACL injuries such as partial tearing. Thermal shrinkage was found to cause an extremely pernicious and nefarious weakening of the ligament, thus greatly heightening the worry of catastrophic injuries due to gross-knee-instability events. A procedure that was initially thought to be harmless and worth a try now turns out to be extremely dangerous and foolhardy to apply.
Abstract
Purpose: The purpose of this study was to determine the acute effects of electrothermal shrinkage on the biomechanical properties of the anterior cruciate ligament (ACL). Type of study: Randomized trial.
Methods: Fifty fresh femur-ACL-tibia complexes harvested from fully matured pigs were used. The femur-anteromedial bundle-tibia complex specimens were randomly divided into 5 groups of 10 specimens each. In each group, radiofrequency energy set at nonablative levels was applied to the anteromedial bundle of the ACL with a bipolar radiofrequency generator. In groups I and II, radiofrequency treatment was applied to the ACL using 28 W and 45 W power, respectively, for 30 seconds. In groups III and IV, radiofrequency treatment was applied to the ACL using 28 W and 45 W power, respectively, for 60 seconds. In group V, no treatment was applied in order to obtain normal control data. The treatment was performed in physiological saline solution under a 1-N load. In each group, 8 of the 10 specimens were used for biomechanical evaluation, and the remaining 2 were used for histologic observation.
Results: Concerning the length of the anteromedial bundle after the treatment, the analysis of variance (ANOVA) showed a significant difference among the 5 groups. The length in groups I, II, III, and IV was significantly shorter than that of group V. In tensile testing, the stiffness was 120, 116, 113, 89, and 156 N/mm in groups I, II, III, IV, and V, respectively. The ANOVA showed a significant difference among the groups. Groups I, II, III, and IV were significantly lower than group V, respectively. Histologic examination showed diffuse collagenous denaturation and pyknotic nuclear changes in fibroblasts at the treated portion. The collagen crimp pattern was not present in the treated area.
Conclusions: Application of RF energy to the specimens caused both shortening and weakening according to the magnitude and duration of the application.
Clinical relevance: These results may explain one of the causes of the poor results reported in some clinical studies. This study warns against a too optimistic application of electrothermal shrinkage to the ACL as a clinical treatment.
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