Treatment of ligament laxity by electrothermal shrinkage or surgical plication: A morphologic and mechanical comparison

Hill, Adam M.; Jones, Ioan T.; Hansen, Ulrich; Suri, Amrita; Sandison, Ann; Moss, Jill; Wallace, Andrew L.

doi:10.1016/j.jse.2006.03.003

« Previous Next »Journal of Shoulder and Elbow Surgery
Volume 16, Issue 1 , Pages 95-100, January 2007

Treatment of ligament laxity by electrothermal shrinkage or surgical plication: A morphologic and mechanical comparison

Adam M. Hill, BSc
- Department of Musculoskeletal Surgery, Imperial College London, London, England
- Department of Bioengineering, Imperial College London, London, England
Ioan T. Jones, FRCS
- Department of Musculoskeletal Surgery, Imperial College London, London, England
Ulrich Hansen, PhD
- Department of Mechanical Engineering, Imperial College London, London, England
Amrita Suri, BSc
- Department of Musculoskeletal Surgery, Imperial College London, London, England
Ann Sandison, FRCP
- Department of Histopathology, Charing Cross Hospital, London, England
Jill Moss, PhD
- Department of Investigative Sciences, Imperial College London, London, England
Andrew L. Wallace, PhD, FRACS
- Department of Musculoskeletal Surgery, Imperial College London, London, England
- Department of Bioengineering, Imperial College London, London, England
- Reprint requests: A. L. Wallace, PhD, FRACS, Consultant Orthopaedic Surgeon, The Shoulder Unit, Hospital of St John and St Elizabeth, 60 Grove End Rd, St John’s Wood, London, W6 8RF, England.

published online 12 October 2006.

Capsular plication or thermal shrinkage can be used to enhance surgical joint stabilization. We compared mechanical or morphologic properties of the medial collateral ligament of the rabbit knee treated by either bipolar radiofrequency electrothermal shrinkage or surgical plication. After 12 weeks, the medial collateral ligaments were procured from treated and contralateral knees to undergo viscoelastic (creep) testing, quantitative transmission electron microscopy, and immunohistochemistry. Creep strain in thermal (1.85% ± 0.32%) and plicated (1.92% ± 0.36%) ligaments was almost twice that of the control group (1.04% ± 0.15%), although there was no difference between treatment modalities. The morphologic parameters of all 3 groups were significantly different (P < .001). The thermal ligaments demonstrated predominantly small fibrils, whereas the plicated group displayed an intermediate distribution of heterogeneous fibrils, suggesting a different pattern of remodeling. Viscoelastic properties are similar after thermal shrinkage or plication, though inferior to those of intact ligaments.