Holmium: YAG-laser-assisted arthroscopy versus conventional methods for treatment of the knee. Two-year results of a prospective study.

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.