[Arthroscopic holmium-YAG laser compared to conventional procedures on the knee joint. 2-year results of a randomized prospective study].

The results of 320 patients after holmium:YAG laser treatment in comparison to conventional mechanical methods during a 2-year period were analyzed in a prospective, randomized study. The following knee injuries were included in the study: meniscal lesion, chondromalacia, combined meniscal/cartilage lesion, rheumatoid synovitis and femoropatellar pain syndrome. Because strict inclusion criteria were used, the patient series is homogeneous, not only in terms of sex, age, injured side and intrasurgical diagnosis, but also because the initial values of the Lysholm score modified after Klein are similar. After 2 years, the results of the laser series were significantly improved, whereas the results for the conventional series, especially for chondromalacia and synovitis, did not show the same improvement. Analysis of the effect of various instrumentation and the laser system itself show differing results for the different knee disorders. The hemostatic effect of the holmium-YAG laser was excellent during surgery for all knee disorders, including surface treatment. The operation time for laser surgery was not prolonged, as is often stated. This study shows that chondromalacia, combined meniscal-cartilage lesions and chronic rheumatoid synovitis are treated more effectively and with better results with the holmium-YAG laser than with conventional arthroscopic methods. Furthermore, laser treatment of meniscectomy and lateral retinacular release is also better than mechanical techniques. This study demonstrates the feasibility of the holmium-YAG laser for arthroscopic surgery. A combination of different instruments seems to be most effective.