The Experimental Treatments Laser chondroplasty Laser abrasion provies gentle cutting of the cartilage as opposed to a mechanical cutting that is known to heat the tissues up to 250 C causing severe collateral damage. It is also preferable to the electrothermal instruments because the laser avoids boiling of the synovial fluid. The pictures below depict the way by which the laser treatment is delivered into the joint with the use of optic fiber. Image credit www.miller-dwan.com Laser assisted cartilage reshaping (chondroplasty) was introduced by Helidonis et al in 1993. It uses heat to cause change in the physical matrix. That change causes relaxation, leading to the change of shape of the cartilage leading stress reduction. There is a fine line between the amount of energy to allow the cartilage relaxation and an excessive amount of energy that would cause the massive death of the heated tissue. There is a need for this therapy to be more spatially selective to avoid excessive damage. Thermal condroplasty using RFE Recently there have been reports about a so called radiofrequency energy (RFE) chondroplasty. It is a method where the partial thickness leisons are treated by RFEC instead of of the electromechanical devices used in regular shaving and debridement procedures to separate loose and unstable cartilage. Image credit: Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 22, No 4 (April), 2006: pp 351-355 In general the undesired consequences of the termal treatment (laser and RFE chondroplasty) encompass thermal damage, air bubble formation, tissue necrosis, reactive synovitis, chondrolysis and an acceleration of articular cartilage degeneration. Below, the image to the left represents the minimal amount of damage RFE probe is able to cause; the image to the right - the maximum amount of damage. Dead chondrocytes are stained red, alive stained green. It is possible to see the excessive tissue death on the picture to the right. Image credit: Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 22, No 4 (April), 2006: pp 351-355     Laser gene activation therapy One paper by Maloney, 2006, tells us about a possible induction of the transcription of the tagged protein by the chondrocytes irradiated with a UVA light of a certain strength. This is not a treatment but just a recent research. The green cells are actively transcripting chondrocytes, and as we can see the amount of transcription directly dependent upon the amount of energy given by the laser to the area of the cartilage. This was an in vitro study Image credit: J Bone Joint Surg Am. 88:753-761, 2006     back to top