18.       Tasto., J. P.; Amiel., D.; and Medlock., V.: Radiofrequency Microdebridement: A Novel Treatment Option for Tendinopathies. Edited, San Diego, CA, 2007.

Coblation is a new application of bipolar RF energy that creates a small, highly energized plasma at the tip of the active electrodes, capable of breaking down molecular bonds of tissue. It appears there may be other biological effects as well. Several studies have confirmed that Coblation-treated tissue exhibits a rapid and effective healing response. This may explain why patients treated in various surgical procedures using Coblation devices appear to recover significantly faster and with less pain than patients treated with conventional therapies. In this paper, three studies were discussed to support the use of Coblation to treat tendinosis. The supraspinatus tendons from eight patients suffering with rotator cuff tears were compared to 6 healthy tendons. The altered tendons exhibited a lack of vascularity, expressed by a lower level of markers such as VEGF and αv integrin. These results confirm the work from Ahmed et al. (15) that tendon ruptures tend to occur in regions of hypovascularity. A controlled study performed on 17 New Zealand white rabbits was conducted to study the effects on local vascularity and healing response of bipolar RF microdebridement in normal Achilles tendons. This study demonstrated that, when properly applied, Coblation devices have the ability to trigger a healing response that provides an increase in tissue vascularity as well as an increase in organized fibroblastic cells. A novel small Coblation device applied for 0.5 second treatments every 5 mm on tendons diagnosed with tendinosis significantly improved the pain symptoms over the short-term in a small group of patients. These results need to be confirmed with longer-term followup and in a larger controlled study, both of which are being undertaken. Treatments for tendinosis include activity modification, non-steroidal anti-inflammatories administration, corticosteroid injections, bracing, physical therapy, surgical debridement and extracorporeal shock wave therapy. This preliminary data has demonstrated both procedure and device safety. It has also documented short-term efficacy of the treatment of tendinosis with the ArthroCare bipolar RF microdebridement system. A larger prospective multi-center controlled study will be conducted to confirm these positive results.