Tabib W, Beaufils P, Blin J L, Trémoulet J, Hardy P
Service de Chirurgie Orthopédique et Traumatologique, Hôpital A. Mignot, Le Chesnay.
Rev Chir Orthop Reparatrice Appar Mot. 1999 Nov;85(7):713-21.
The theoretical advantages of the Ho-Yag laser make it the ideal instrument for current use in arthroscopic meniscectomy. Short term results showed less patient discomfort, rapid recovery and less post operative pain and swelling. The purpose of this single blind prospective randomized study was to compare the results of arthroscopic meniscectomy performed mechanically to those obtained with the Ho-Yag laser, with a minimum follow up of one year.
Eighty meniscectomies in 76 patients were included with a mean follow up of 19.5 months (extremes 12-35 months). The mean age was 42.5 years (extremes 18-65 years). The laser group included 39 patients while the mechanical group included 37 patients. In the Ho-Yag laser group, energy never exceeded 30 watts. During arthroscopic meniscectomy, no other surgical procedure was allowed i.e. chondroplasty, ligament surgery. Prior to arthroscopy, all patients underwent a clinical evaluation including: Pain and Lysholm score assessment. This was repeated in the post operative period at the 10th, 30th day and at last follow up. 37 patients also had a standard X ray at last follow up (anterior-posterior, lateral, and schuss views).
No statistically significant difference was observed in global clinical results between both techniques. Even if mechanical meniscectomy showed better results, the laser remained best when used in degenerative medial meniscal tears with minimal cartilaginous lesions. In degenerative medial meniscal tears with severe cartilaginous lesions, mechanical meniscectomy showed significantly better results (p = 0.048). X ray control was normal in 47 p. 100 of the laser group and in 80 p. 100 of the mechanical group. The difference was statistically significant (p = 0.038). Narrowing of the joint space was observed in 45 p. 100 of laser group and in 18 p. 100 of mechanical group. Iterative arthroscopy was necessary in 4 cases (3 laser and 1 mechanical) for residual pain. Severe chondrolysis was present in 2 cases following laser meniscectomy. In the 2 other cases a complement of meniscectomy for residual lesions allowed good results. No bony necrosis was observed after laser meniscectomy.
According to the results of this study and the high cost of the laser, we do not recommend the laser as a routine technique for arthroscopic meniscectomy.
钬-钇铝石榴石激光的理论优势使其成为目前关节镜下半月板切除术的理想工具。短期结果显示患者不适更少、恢复迅速且术后疼痛和肿胀较轻。这项单盲前瞻性随机研究的目的是比较机械性关节镜下半月板切除术与钬-钇铝石榴石激光手术的结果，最短随访期为一年。
纳入76例患者的80例半月板切除术，平均随访19.5个月（范围12 - 35个月）。平均年龄为42.5岁（范围18 - 65岁）。激光组包括39例患者，机械组包括37例患者。在钬-钇铝石榴石激光组，能量从未超过30瓦。在关节镜下半月板切除术中，不允许进行其他手术操作，即软骨成形术、韧带手术。在关节镜检查前，所有患者均接受临床评估，包括：疼痛和Lysholm评分评估。在术后第10天、第30天及最后随访时重复进行。37例患者在最后随访时还进行了标准X线检查（前后位、侧位和斜位片）。
两种技术在总体临床结果上未观察到统计学显著差异。即使机械性半月板切除术显示出更好的结果，但在伴有最小软骨损伤的退行性内侧半月板撕裂中使用激光时效果仍然最佳。在伴有严重软骨损伤的退行性内侧半月板撕裂中，机械性半月板切除术显示出明显更好的结果（p = 0.048）。激光组47%的患者和机械组80%的患者X线检查正常。差异具有统计学意义（p = 0.038）。激光组45%的患者和机械组18%的患者观察到关节间隙变窄。4例患者（3例激光手术和1例机械手术）因残留疼痛需要再次关节镜检查。激光半月板切除术后2例出现严重软骨溶解。在另外2例中，对残留病变进行补充半月板切除术取得了良好效果。激光半月板切除术后未观察到骨坏死。
根据本研究结果以及激光的高成本，我们不推荐将激光作为关节镜下半月板切除术的常规技术。
