In spite of the many improvements in arthroscopic surgical techniques for the treatment of mild to moderate degree degenerative joint diseases which were resistant to conservative treatment, the results are variable, showing a tendency to decline in therapeutically following the passage of time. Using a 2.1 un holmium: YAG laser we operated on patients with mild to moderate degenerative joint diseases which had not improved through conservative treatment. We evaluated the results of arthroscopic laser surgery for degenerative joint disease and investigated the proper indication and complications of laser surgery. We operated on 28 knees of 28 patients between July 1995 and June 1996. There were 16 females and 12 males. The average follow-up period was 16.3 months and the average age was 54.5 years. Under epidural or general anesthesia, we used arthroscopic tools, including laser, and the laser power was modified according to the type of operation (chondroplasty: 1.0Jx20pulse/sec, meniscectomy: 2.0Jx15pulse/sec, bone drilling: 2.5Jx10 pulse/sec). We used Bauer & Jackson's classification of articular cartilage change, and performed 12 laser chondroplasties in grade II, III, V lesions, 16 chondroplasties and laser bone drilling in grade IV, VI lesions, 16 laser meniscectomies, 6 laser synovectomies and 2 lateral retinacular releases. Medial femorotibial arthritis was the most common site. Postoperative results by Orgilvis-Harris & Fitsialos's methods indicated that 82% of treated patients were satisfied and only two patients (7%) did not improve. As a postoperative complication, eight patients complained of postoperative effusion which was subsided by medication and physical therapy. We performed second-look arthroscopic examinations in four knees that had been treated with laser chondroplasy and drilling. Regenerated tissues at the operated site were observed in three cases, but denuded articular cartilage and naked subchondral bone at the operated site were found in one case as a sign of osteonecrosis. Concluding this short-term study, 2.1 holmium: YAG laser in arthroscopic surgery seems to be effective in mild to moderate degenerative joint disease but care should be taken to avoid thermal injuries to the adjacent normal cartilages.
Anesthesia, General ; Arthritis ; Arthroscopy ; Cartilage ; Cartilage, Articular ; Classification ; Female ; Follow-Up Studies ; Holmium* ; Humans ; Joint Diseases ; Knee Joint* ; Knee* ; Laser Therapy ; Lasers, Solid-State* ; Male ; Osteoarthritis* ; Osteonecrosis ; Postoperative Complications ; United Nations

PURPOSE: The purpose of this paper was to investigate whether the reflected synovio-capsular flap, covering one-third of the remaining peripheral after partial removal of two-thirds of the central medial meniscus of rabbit knee, contributes to the regeneration of meniscus. MATERIALS AND METHODS: Forty rabbits were used in this study. In each rabbit the right knee was used for the experimental group in which the synovio-capsular flap was reflected after a partial meniscectomy, while the left knee, with only a skin incision, was used for the control group. The width and thickness of the regenerated menisci were measured with the Vernier calliper, and evaluated grossly by Hematoxylin-Eosin (H-E) staining, histochemically by safranin-O staining, and subcellularly by transmission electron microscopy at 4, 8, 12 and 16 weeks after the operation. RESULTS: The width and thickness of reflected synovio-capsular flaps gradually decreased until reaching a normal size. After eight weeks, there was no statistical difference between the experimental and control group. Twelve weeks after the operation, immature fibrocartilage cells appeared in the central portion of the reflected synovio-capsular flaps in 7 out of 8 rabbit knees. Sixteen weeks after the operation, more mature cartilage cells and their halos, stained very deeply with safranin-O, appeared in 6 out of 8 rabbit knees. In electron microscopic examination of cell shape, normal cell process and nuclear shape were observed with the passage of time. Rough endoplasmic reticulum and chromatin transparence peaked at 12 weeks and gradually returned to normal shape at 16 weeks. CONCLUSIONS: The results showed that the reflected synovio-capsular flap in rabbit was incorporated with the remaining peripheral portion of the meniscus and became a normal meniscus-like structure.
Cartilage ; Cell Shape ; Chromatin ; Endoplasmic Reticulum, Rough ; Fibrocartilage ; Knee ; Menisci, Tibial ; Microscopy, Electron, Transmission ; Rabbits ; Regeneration ; Skin