Arthroscopic meniscectomy using Ho-Yag Laser versus mechanical instruments: A prospective single blind randomized study on 80 meniscectomies

Introduction The theoretical advantages of the Ho-Yag laser make it the ide al instrument for current use in arthroscopic meniscectomy. Short term resu lts 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 mec hanically to those obtained with the Ho-Yag laser, with a minimum follow up of one year. Materials and methods Eighty meniscectomies in 76 patients were included wi th a mean follow up of 19.5 months (extremes 12-35 months). The mean age wa s 42.5 years (extremes 18-65 years). The laser group included 39 patients w hile 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. Pai n and Lysholm score assessment. This was repeated in the post operative per iod at the 10th, 30th day and at last follow up. 37 patients also had a sta ndard X ray at last follow up (anterior-posterior, lateral, and schuss view s). Results No statistically significant difference was observed in global clin ical results between both techniques. Even if mechanical meniscectomy showe d better results, the laser remained best when used in degenerative medial meniscal tears with minimal cartilaginous lesions. In degenerative medial m eniscal tears with severe cartilaginous lesions, mechanical meniscectomy sh owed 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 join t space was observed in 45 p. 100 of laser group and in 18 p. 100 of mechan ical group. Iterative arthroscopy was necessary in 4 cases (3 laser and 1 m echanical) for residual pain. Severe chondrolysis was present in 2 cases fo llowing laser meniscectomy. In the 2 other cases a complement of meniscecto my for residual lesions allowed good results. No bony necrosis was observed after laser meniscectomy. Conclusion 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 arthroscopi c meniscectomy.