The use of the contact Nd:YAG laser in arthroscopic surgery: effects on articular cartilage and meniscal tissue

The contact Nd:YAG laser's small size, tip variety, fiberoptic application, and suitability for use in a saline medium make it a particularly appealing tool for use in arthroscopic procedures. This study was performed to investigate the laser's effects on articular cartilage and meniscal tissue with respect to depth of damage (canine cadaver model) and healing response (rabbit model). Depth of damage in the canine cadaver model was greater in meniscal tissue than in articular cartilage at each wattage level. In the presence of a saline bath, depth damage in both tissues was diminished. Scalpel articular cartilage lesions showed no response over time. Electrocautery lesions uniformly showed significant wide margins of hyaline cartilage necrosis which increased over time. Laser articular cartilage lesions showed vigorous healing responses characterized by fibrocartilage healing by 6 weeks. Scalpel meniscectomies showed characteristic fibrocartilagenous remodeling by 6 weeks, while electrocautery meniscectomies showed wide margins of necrosis with no specimen showing remodeling capability. Laser meniscectomies showed an intermediate response with a small number of menisci remodeling in a normal fashion. This article represents the first comprehensive look at the effects of the Nd:YAG laser on articular cartilage and meniscal tissue in terms of depth of damage and healing response over time, and indicates this laser's biological advantage over scalpel and electrocautery in arthroscopic procedures.