Complications of thermal energy in knee surgery--Part II.
With the theoretical and reported complications of thermal energy use in the knee, an analysis of potential risks and benefits should be done on a case-by-case basis. Many of the basic science studies may not be directly applicable to clinical practice because they use normal (i.e., not diseased) tissues in animal models. Clinical studies are also dependent on surgical technique and equipment settings. With the benefits listed previously, however, it is likely that thermal energy will continue to play an important role in arthroscopic orthopedic surgery, and there are studies that strongly support its safety and efficacy. Janecki performed a retrospective review of 504 laser chondroplasties to determine safe parameters for Ho:YAG laser use in the knee [10]. In their series, they found an 88% patient satisfaction rate, no significant changes in the articular cartilage lesions in the failure group who underwent repeat arthroscopy, and no new cases of osteonecrosis. They concluded that the Ho:YAG laser was safe and recommended energy settings of less than or equal to 1 joule when performing chondroplasties, noncontact and tangential delivery of the laser beam, and maximizing laser spot size as methods for further decreasing complication rates. We agree with the above recommendations and with using the minimal power settings required to afford the desired surgical result. More studies are required to fully define the indications and consequences of thermal energy use in the knee.
Lee
Eric W
EW
Orthopedic Specialty Hospital, 5848, South Fashion Blvd (300 East), Salt Lake City, UT 84107, USA. torjones@ihc.com
Paulos
Lonnie E
LE
Warren
Russell F
RF
D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D019902:Chondrocytes; D004598:Electrosurgery / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007718:Knee Injuries / Q000473:pathology / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D010020:Osteonecrosis; D017060:Patient Satisfaction; D012421:Rupture