The use of lasers in operative orthopedics – an update

Abstract

In laser-assisted arthroscopic knee surgery, clinical outcome and experimental results are quite different. After laser treatment of local chondromalacia, large cartilage lesions with less tendency towards repair were more often seen than after conventional arthroscopic treatment. Therefore, laser treatment of chondromalacia cannot be recommended. Compared with conventional meniscectomy, laser-assisted meniscal surgery has some advantages, but there is also some risk of inducing gonarthrosis. Some studies show a good hemostatic effect of the laser and the feasibility of precise tissue cutting. On the other hand, laser treatment causes alteration of the tissue. The meniscal tissue becomes stiffer, which may promote the manifestation of gonarthrosis. Percutaneous laser disc decompression has been in successful clinical use since 1986 in the treatment of intervertebral disc prolapses. Studies of multiple orthopedic departments worldwide show a success rate of 75%. To guarantee the success the indications must be observed. The use of lasers in the arthroscopic treatment of outlet impingement syndrome have some advantages, too. The outcome is better than that of other arthroscopic techniques and there are fewer complications because of the hemostatic effect and the improved vision. Laser-assisted capsular shrinkage combined with arthroscopic labrum reattachment allows conventional laser use. Capsular shrinkage can be achieved with low-level laser energy. If this treatment is not successful, other operative techniques can be performed without restrictions.