In vitro analysis of laser meniscectomy.
Partial meniscectomies were performed on 32 fresh human meniscal autopsy specimens. The following laser systems were tested: carbon dioxide (CO2), neodymium:yttrium aluminum garnet (Nd:YAG), potassium titanyl phosphate (KTP), holmium:YAG (Ho:YAG), and excimer. Meniscectomies with these lasers were compared with scalpel, mechanical, and electrocautery meniscectomies. Lasers were applied to specimens in and out of normal saline. Routine hematoxylin and eosin and sirius red sections were prepared for each specimen, and the depths of thermal changes were analyzed. Scanning electron microscopy was used to visualize the meniscectomy interface. Among these specimens, the scalpel and mechanical meniscectomies showed the least extension of cellular changes (range, 10-15 nm). The excimer laser caused the least tissue changes of the lasers tested. Tissue changes were less extensive with the pulsed CO2 laser than with the holmium:YAG, neodymium:YAG, and KTP lasers. Scanning electron microscopy showed that use of the scalpel meniscectomy resulted in the smoothest meniscectomy edge, followed by use of the excimer, CO2, holmium:YAG, neodymium:YAG, and KTP lasers. The most surface disruption occurred with electrocautery. Meniscectomies under saline required more energy and took longer in each case, with the holmium:YAG, neodymium:YAG, and CO2 laser cutting the best. Saline meniscectomies showed less thermal change. The CO2 and KTP lasers cut best in air.
Vangsness
C T
CT
Department of Orthopaedic Surgery, University of Southern California, Los Angeles 90033, USA.
Akl
Y
Y
Nelson
S J
SJ
Liaw
L H
LH
Smith
C F
CF
Marshall
G J
GJ
D000328:Adult; D002102:Cadaver; D004564:Electrocoagulation; D005069:Evaluation Studies as Topic; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008592:Menisci, Tibial / Q000601:surgery* / Q000648:ultrastructure; D008875:Middle Aged