Holmiumlaser versus mechanische knorpelabtragung

Möller, K. O.; Lind, B. M.; Kärcher, K. H.; Hohlbach, G.

doi:10.1007/bf00195869

Cited by 9 publications

(3 citation statements)

References 17 publications

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“…These results conform to the few clinical studies on cartilaginous laser application [2,4,7,15,22,29]. On the other hand, there are several experimental studies with contradictory results [7,9,18,20,23,28,32]. Because the laser was applied very carefully and tangentially in an unfocussed system in this study, unlike some experimental studies with negative results, comparison is not possible.…”

Section: Discussionsupporting

confidence: 82%

Holmium :YAG-laser-assisted arthroscopy versus conventional methods for treatment of the knee

Lübbers

Siebert

1997

Knee Surgery, Sports Traumatology, Arthroscopy

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The results of 320 arthroscopic procedures are reported here, in which laser surgery using the holmium: YAG laser is compared with conventional mechanical methods. The patients were followed-up during a 2-year period and the data analyzed in a prospective study. The following knee injuries were included: meniscal lesion, chondromalacia, combined meniscal/cartilage lesion, rheumatoid synovialitis and patellofemoral pain syndrome. Because strict inclusion criteria were used, the patient collective is homogenous. Gender, age, injured side, intrasurgical diagnosis, and the initial values of the Lysholm score (modified after Klein) are congruous. After 2 years, the results of the laser collective were significantly improved, whereas the results for the conventional collective, especially for chondromalacia and synovialitis, did not show the same improvement. Analysis of the effect of various instruments and the laser system itself show differing results for the various knee disorders. The hemostatic effect of the holmium: YAG laser was excellent during surgery of all knee disorders, including surface treatment. Operating time for laser surgery was not prolonged, in contrast to what is often claimed. This study shows that chondromalacia, combined meniscal-cartilage lesions, and chronic rheumatoid synovialitis are treated more effectively and with better results with the holmium: YAG laser than with conventional arthroscopic methods. Furthermore, laser treatment of lateral retinacular release can be considered to be better than mechanical techniques. No significant advantage can be found for using the laser during meniscectomy. Lasers are useful for treating smaller, hard-to-reach joints and lower the risk of iatrogenic cartilage damage. The holmium: YAG laser is a suitable instrument for arthroscopic surgery.

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Section: Discussionsupporting

confidence: 82%

Holmium :YAG-laser-assisted arthroscopy versus conventional methods for treatment of the knee

Lübbers

Siebert

1997

Knee Surgery, Sports Traumatology, Arthroscopy

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“…After conventional arthroscopy with partial meniscal resection an increased load transmitted to the already injured cartilage has been hypothesized to result in subchondral microfractures or changes in the subchondral blood supply, typically leading to avascular necrosis in the elderly [19, 20]. Although laser‐assisted surgery‐induced osteonecrosis as a result of thermal or photoacoustic tissue damage to the underlying matrix has been described, few reports have considered that a similar effect could result from the use of RFE devices [12, 13, 21, 22]. Most recently, Bonutti and colleagues presented a series of nineteen patients treated with knee arthroplasty for osteonecrosis.…”

Section: Discussionmentioning

confidence: 99%

Impact of monopolar radiofrequency energy on subchondral bone viability

Balcarek

Kuhn

Weigel

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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The purpose of this study was to analyze the impact of monopolar radiofrequency energy treatment on subchondral bone viability. The femoral grooves of six chinchilla bastard rabbits were exposed bilaterally to monopolar radiofrequency energy for 2, 4 and 8 s, creating a total of 36 defects. An intravital fluorescence bone-labeling technique characterized the process of subchondral bone mineralization within the 3 months following exposure to radiofrequency energy and was analyzed by widefield epifluorescence optical sectioning microscopy using an ApoTome. After 2 s of radiofrequency energy exposure, regular fluorescence staining of the subchondral bone was evident in all samples when compared to untreated areas. The depth of osteonecrosis after 4 and 8 s of radiofrequency energy treatment averaged 126 and 942 µm at 22 days (P < .05; P < .01). The 4 s treatment group showed no osteonecrosis after 44 days whereas the depth of osteonecrosis extended from 519 µm at 44 days (P < .01), to 281 µm at 66 days (P < .01) and to 133 µm at 88 days (P < .05) after 8 s of radiofrequency energy application. Though radiofrequency energy may induce transient osteonecrosis in the superficial zone of the subchondral bone, the results of this study suggest that post-arthroscopic osteonecrosis appears to be of only modest risk given the current clinical application in humans.

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“…So fanden Siebert et al[30] in rasterelektronenmikroskopischen Untersuchungen im Vergleich mehrerer Lasersysteme fu Èr den Erbium : YAG-Laser erheblich gu Ènstigere Ergebnisse. Dagegen wiesen Mo Èller et al[21] nach Knorpelabtragungen am Kaninchen mit dem Holmium : YAG-Laser nach experimentell erzeugten Arthrosen regelma Èûig deutliche Knorpelnekrosen nach. Dabei waren in dieser Untersuchung die Ergebnisse im Vergleich nach konventionell mechanischer Gla Èttung erheblich gu Ènstiger.Wa Èhrend die eigenen histologischen und rasterelektronenmikroskopischen Untersuchungen u Èbereinstimmend mit den Ergebnissen anderer Untersucher[9,25,30] eine exakte und pra Èzise Schneidecharakteristik des Excimerlasers sowohl am Gelenkknorpel als auch bei der Penetration der subchondralen Knochenlamelle[15,33,34] zeigen, so du Èrfen die Nachteile der Laseranwendung, die in der Literatur mittlerweile belegt sind, nicht auûer acht gelassen werden.…”

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