Medical Policy

This document addresses the use of Coblation (Smith & Nephew, Austin, TX), also known as cold ablation, radiofrequency microdebridement or radiowave tissue removal, for the treatment of musculoskeletal conditions involving the ankle and foot, elbow, hip, knee, shoulder, and wrist.

Note: Please see the following documents for other proposed uses of Coblation technology or other related indications:

• SURG.00071 Percutaneous Spinal Surgery
• SURG.00100 Cryoablation for Plantar Fasciitis and Plantar Fibroma
• SURG.00129 Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Investigational and Not Medically Necessary:

The use of Coblation technology is considered investigational and not medically necessary for the treatment of musculoskeletal conditions.

This document describes clinical studies and expert recommendations, and explains whether Coblation for the treatment of musculoskeletal conditions is clinically appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

Coblation (also referred to as cold ablation, radiofrequency microdebridement or radiowave tissue removal) is a treatment that uses radio wave energy with salt water or gel to break apart a small area of tissue. It is sometimes called “cold” or “controlled” tissue removal because it is meant to make less heat than some other tools. It may be used during procedures on the ankle, foot, elbow, hip, knee, shoulder, or wrist.

What the Studies Show

The studies reviewed do not show that Coblation improves health for muscle, tendon, or joint problems. The currently published studies for Coblation for muscle, tendon, or joint problems included few people, did not compare Coblation to other treatments, or looked back at records after treatment was done. Testing is needed with larger groups and comparison to other accepted surgical methods to know whether the treatment improves health.

Is this Clinically Appropriate?

Coblation for muscle, tendon, or joint problems of the ankle and foot, elbow, hip, knee, shoulder, or wrist is not clinically appropriate because it has not been proven to improve health. The studies reviewed were not designed well enough to show whether Coblation is safer or works better than standard treatments. Better studies are needed to know if Coblation improves health.

(Return to Description/Scope)

Summary

Coblation, also known as cold ablation, radiofrequency microdebridement or radiowave tissue removal, has been studied for several musculoskeletal conditions, including Achilles tendinopathy, shoulder impingement/subacromial pain, gluteal tendinopathy, lateral epicondylitis, cervical discogenic pain, and plantar fasciitis. Across available studies, participants often improved after treatment, but randomized trials generally found no significant advantage over comparison treatments, and many studies were limited by small sample sizes, retrospective design, or lack of control groups. Overall, better-designed randomized controlled trials with long-term follow-up are needed to confirm the safety and efficacy of Coblation compared with established treatments.

Discussion

Coblation is a type of radiofrequency ablation referred to as “cold” or “controlled” ablation. Coblation devices direct radiofrequency energy through a liquid medium, rupturing target tissue cells, and disintegrating molecules with minimal heat production. Coblation technology can be delivered by a variety of wands, hand pieces and stylette tips used at different anatomic sites.

A 2017 randomized, controlled trial by Morrison reported on 36 participants with Achilles tendinosis who received either Coblation (n=20) or traditional surgical decompression (n=16). Using the visual analog scale (VAS), at 6 months following treatment, there was no significant difference (p>0.05) between the treatment groups.

Another randomized trial compared the use of physical therapy (n=18) to radiofrequency microtenotomy using Coblation (n=20) for treatment of Achilles tendinopathy (Al-Ani, 2021). Participants were followed for 2 years and assessments were done using VAS, the Foot and Ankle Outcome Score (FAOS), and magnetic resonance imaging (MRI). Both groups showed improvement after 2 years. The Coblation group showed a lower mean VAS score at 2 years when compared to the physical therapy group (1.0±1.4 vs. 3.1±1.8, respectively). It was also reported that the FAOS showed significant improvement in the Coblation group compared to the physical therapy group. No significant differences were found on MRI evaluation between the two groups. Strengths of the study include the randomized design and that none of the participants were lost to follow-up. Limitations include the small number of participants, which may have led to the study being underpowered. The authors also note significant differences in the VAS scores and MRI results prior to treatment which may have introduced bias in the study.

A 2013 randomized trial by Lee reported results of 80 individuals with shoulder impingement syndrome treated with either arthroscopic subacromial decompression alone (n=40) or arthroscopic subacromial decompression combined with radiofrequency microtenotomy using Coblation (n=40). Participants were followed for 1 year following treatment with 65 participants available for analysis. Both groups showed improvement following treatment, however, there were no significant differences between the groups. The authors concluded “The additional radiofrequency based plasma microtenotomy showed no significant positive effects regarding pain relief on the VAS score, range of motion (ROM), or functional recovery at any given time point postoperatively.”

In 2019, Al-Ani reported results of a randomized controlled trial for 27 participants with subacromial pain syndrome who received either arthroscopic acromioplasty (n=14) or radiofrequency microtenotomy using Coblation (n=13). Outcomes were measured at 12 weeks, 6 months, and 2 years using VAS scores, the Constant score and strength by a dynamometer. All participants showed reduced pain using the VAS with significant reduction in pain in both groups after 2 years. Both treatment groups also showed improvement in Constant score and improvement in strength. However, there were no significant differences between the two treatment groups at follow-up. Strengths of the study include the randomization and comparison group. However, limitations include the small number of participants which present the possibility the study is underpowered.

A double-blind, randomized controlled trial by Blakey in 2020 reported on 33 individuals with gluteal tendinopathy who received either arthroscopic gluteal bursectomy (AGB) and ilioband release (ITBR) (n=16) or AGB/ITBR plus radiofrequency microdebridement using Coblation (n=17). The primary outcome was change in the modified Harris Hip Score (mHHS). Participants were followed for 1 year after treatment. Both treatment groups showed significant improvement in the mHHS, however, there was no statistical difference between the treatment groups (p=0.75). A strength of the study is the double-blind and randomized design, however limitations include the small size which may have led to lack of power. The authors note “In this small RCT, the addition of RFMD showed no additional benefit to AGB/ITBR but provided a safe adjunct for the surgical management of recalcitrant gluteal tendinopathy.”

Several prospective, randomized trials have compared the use of microtenotomy using Coblation to open or arthroscopic release for the treatment of recalcitrant lateral epicondylitis (Hamlin, 2017; Lee, 2018; Meknas, 2013). In all studies, both treatment groups reported significant improvements in symptoms following treatment, but none of the studies reported significant differences between the two treatment groups.

A 2021 case series by Pandolfi and colleagues included 18 individuals with cervical discogenic pain that was not responsive to 3 months of conservative care. Individuals were treated with percutaneous disc compression using Coblation technology. The mean VAS score was 7.9 (standard deviation [SD], 1.6) before the procedure, 2.5 (SD, 3.1) at the 3- to 4-month follow-up and 2.5 (SD, 2.5) at the 2-year follow-up. As with other case series, the study had a small sample size and lacked a comparison group.

In 2026, Acharya published the results of a retrospective, observational study of 18 individuals with recalcitrant plantar fasciitis who underwent percutaneous plantar fasciotomy using the TOPAZ microdebrider Coblation wand. Outcomes included pain assessed using the Foot and Ankle Ability Measure (FAAM) score and the Numeric Rating Scale (NRS). The mean preoperative NRS score was 7.56 compared to 2.83 at 1 year postoperative. The mean preoperative FAAM score was 59.94 compared to 91.33 postoperative. While both outcomes showed improvement postoperatively, the retrospective nature and lack of a comparison group do not permit firm conclusions regarding improvement in net health outcomes. Larger studies including randomized controlled trials are warranted.

Well-designed randomized controlled trials with appropriate controls reporting long-term outcomes are needed to demonstrate the safety and efficacy of Coblation technology compared with established methods of management of musculoskeletal conditions.

Coblation also known as cold ablation, radiofrequency microdebridement or radiowave tissue removal, is a form of bipolar radiofrequency energy technology in which the current does not pass directly into the tissue, thereby producing minimal thermal injury to surrounding tissues. The mechanism of action involves combining bipolar radiofrequency energy with a conductive solution such as gel or saline. An electrode wand device forms a vapor that subsequently breaks down, producing ions in a gas plasma layer. The formed reactive plasma particles are able to break molecular bonds within the targeted tissue. The ArthroCare Corporation created Coblation devices for intraoperative use to assist with hemostasis in a number of surgical settings including cosmetic, urology, spine and neurology, ear, nose and throat, gynecology, and laparoscopy/general surgery. ArthroCare has been acquired by Smith & Nephew.

The U.S. Food and Drug Administration (FDA) granted 510(k) clearance to ArthroCare TOPAZ ArthroWands (FDA, 2006) and the Werewolf Coblation System and Coblation Halo Wand (FDA, 2019) as Class II electrosurgical cutting and coagulation devices. Commercially available Coblation devices (ArthroCare Sports Medicine) include a broad range of surgical wands used by orthopedic surgeons to perform minimally invasive arthroscopic procedures to the ankle and foot, elbow, hip, knee, shoulder, and wrist, and may involve soft tissue debridement, subacromial decompression, meniscal removal and sculpting, or tendon debridement.

Bipolar radiofrequency: A radiofrequency device that contains both the active and return electrodes in the probe.

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Investigational and Not Medically Necessary:
When the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.

Peer Reviewed Publications:

1. Acharya KKV, Kundapur A, Kumar S. Efficacy of TOPAZ coblation-assisted percutaneous fasciotomy in chronic plantar fasciitis. Foot (Edinb). 2026; 66:102212.
2. Al-Ani Z, Jacobsen EW, Kartus JT, et al. Radiofrequency microtenotomy: a promising method for treatment of rotator cuff tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2019; 27(12):3856-3863.
3. Al-Ani Z, Meknas D, Kartus JT, et al. Radiofrequency microtenotomy or physical therapy for Achilles tendinopathy: results of a randomized clinical trial. Orthop J Sports Med. 2021; 9(12):23259671211062555.
4. Blakey CM, O’Donnell J, Klaber I, et al. Radiofrequency microdebridement as an adjunct to arthroscopic surgical treatment for recalcitrant gluteal tendinopathy: a double-blind, randomized controlled trial. Orthop J Sports Med. 2020; 8(1):2325967119895602.
5. Hamlin K, Munro C, Barker SL, et al. Open release versus radiofrequency microtenotomy in the treatment of lateral epicondylitis: a prospective randomized controlled trial. Shoulder Elbow. 2018; 10(1):45-51.
6. Khan AM, Fanton GS. Thermal energy in the knee. Techniques in Knee Surgery. 2004; 3(3):180-186.
7. Lee JH, Park I, Hyun H, Shin S. A comparison of radiofrequency-based microtenotomy and arthroscopic release of the extensor carpi radialis brevis tendon in recalcitrant lateral epicondylitis: a prospective randomized controlled study. Arthroscopy. 2018; 34(5):1439-1446.
8. Levine MJ, Shaffer B. Basic science applications of thermal energy in arthroscopic surgery. Sports Med Arthro Rev. 2005; 13(4):186-192.
9. Loh C, Polzer S, Millar N, Challoumas D. Efficacy of radiofrequency microdebridement (TOPAZ) in tendinopathy: a systematic review and meta-analysis of randomised clinical trials. J Orthop Surg Res. 2026; 21(1):302.
10. Lu Y, Zhang Q, Zhu Y, Jiang C. Is radiofrequency treatment effective for shoulder impingement syndrome? A prospective randomized controlled study. J Shoulder Elbow Surg. 2013; 22(11):1488-1494.
11. Meknas K, Al Hassoni TN, Odden-Miland A, et al. Medium-term results after treatment of recalcitrant lateral epicondylitis: a prospective, randomized study comparing open release and radiofrequency microtenotomy. Orthop J Sports Med. 2013; 1(4):2325967113505433.
12. Morrison R, Brock TM, Reed MR, Muller SD. Radiofrequency microdebridement versus surgical decompression for Achilles tendinosis: a randomized controlled trial. J Foot Ankle Surg. 2017; 56(4):708-712.
13. Owens BD, Stickles BJ, Balikian P, Busconi BD. Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy. 2002; 18(2):151-155.
14. Pandolfi M, Galli F, Borelli A, et al. Percutaneous cervical coblation as therapeutic technique in the treatment of algo-dysfunctional pain of discal herniation. Radiol Med. 2021; 126(6):860-868.
15. Sherk HH, Vangsness CT, Thabit G III, Jackson RW. Electromagnetic surgical devices in orthopaedics. Lasers and radiofrequency. J Bone Joint Surg Am. 2002; 84-A(4):675-681.
16. Tasto JP, Cummings J, Medlock V, et al. Microtenotomy using a radiofrequency probe to treat lateral epicondylitis. Arthroscopy. 2005; 21(7):851-860.
17. Weil L Jr, Glover JP, Weil LS Sr. A new minimally invasive technique for treating plantar fasciosis using bipolar radiofrequency: a prospective analysis. Foot Ankle Spec. 2008; 1(1):13-18.

Government Agency, Medical Society, and Other Authoritative Publications:

1. U.S. Food and Drug Administration (FDA). 510(k) Premarket Notification Database. ArthroCare^® Topaz™ ArthroWands^® Device Summary. No. K053567. Rockville, MD: FDA. March 6, 2006. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf5/K053567.pdf. Accessed on June 22, 2026.
2. U.S. Food and Drug Administration (FDA). 510(k) Premarket Notification Database. Werewolf™ Coblation™ System and Coblation™ Halo™ Wand Device Summary. No. K192027. Rockville, MD: FDA. December 20, 2019. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf19/K192027.pdf. Accessed on June 22, 2026.

ArthroWand
Atlas System Controller
Bipolar Radiofrequency Electrosurgery
Cold Ablation
Non-Thermal Volumetric Tissue Reduction
TOPAZ EPF MicroDebrider 45
TOPAZ MicroDebrider with Integrated Finger Switches (IFS)
TOPAZ ICW
TOPAZ XL ICW
WEREWOLF Coblation System

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Federal and State law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically.

No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan.