Radiofrequency energy in the arthroscopic treatment of knee chondral lesions: a systematic review.

INTRODUCTION: Cartilage debridement is one of the recommended procedures for the management of chondral defects. Radiofrequency probes allow to debride the cartilage, but may induce subchondral bone necrosis. SOURCES OF DATA: Medline, Cochrane and Google Scholar were searched to identify studies on arthroscopic debridement of the articular cartilage of the knee using radiofrequency chondroplasty. The methodological quality of the studies was assessed using the Coleman methodology score (CMS). AREAS OF AGREEMENT: Monopolar and bipolar radiofrequency devices provide significantly better clinical outcomes, especially for patients with high-grade chondral lesions, compared with mechanical shaver only. Despite the original concerns regarding subchondral bone necrosis, low complication rates are reported. AREAS OF CONTROVERSY: Heterogeneity in terms of type of device does not allow sound comparison of the published results. There is lack of evidence on the long-term effects of radiofrequency chondroplasty. GROWING POINTS: Study methodology should be improved: the average Coleman methodology score was 56.2 out of 100. RESEARCH: More comparative, well-designed and larger cohort trials are needed to ascertain whether radiofrequency chondroplasty offers long-term benefits over other simpler and more economical alternatives.

Hemiarthroplasty in a patient affected by osteonecrosis of the first metatarsal head following chevron osteotomy: a case report.

Osteonecrosis of the first metatarsal head after distal metatarsal osteotomy is a rare condition. Latter stages with complete destruction of the metatarsophalangeal joint often required arthrodesis in order to relieve pain and improve function. We present a case of a 50-years old woman who developed osteonecrosis of the first metatarsal head after distal chevron osteotomy which was successfully treated with hemiarthroplasty of the proximal phalanx. Although longer follow-up and larger number of patients is needed to draw valid conclusions, the current result is encouraging and can be suggested in similar cases.