Matrix Assessment of the Articular Cartilage Surface after Chondroplasty with the Holmium: Yttrium-Aluminum-Garnet Laser
Abstract & Commentary
Synopsis: Unrecoverable chondrocyte death was noted for cartilage lesions independent of variations of treatment angle with the laser.
Source: Lane JG, et al. Matrix assessment of the articular cartilage surface after chondroplasty with the Holmium: Yttrium-Aluminum-Garnet Laser: A long-term study. Am J Sports Med. 2001;29(6):704-708.
Laser and electrothermal chondroplasties are common treatment for cartilage defects in the knee. Stabilization of loose edges by sealing the surface back to bone is appealing but the long-term outcome of the articular cartilage has not been fully studied. This study addresses the long-term follow-up of cartilage surfaces on 40 New Zealand white rabbits.
A standard lesion was created on each medial femoral condyle and trochlear grove of the rabbits. They were randomized to 1 of 2 groups based on the energy mode (perpenducular vs parallel). A biochemical assessment of the cartilage tissue was studied at specified intervals up to 26 weeks.
The results indicated that the chondrocyte destruction noted early on did not resolve by 26 weeks and cellular viability did not recover. The differences in method of delivery (perpendicular vs parallel) did not alter the results.
Comment by James R. Slauterbeck, MD
Arthroscopic treatments of injured or degenerative cartilage with laser and thermal energy are relatively new treatments for orthopedic surgeons. This study should bring concern to those who implore this treatment on their patients. In this case, the first to jump on the bandwagon may be the first to jump off.
Unfortunately, I have had the opportunity to operate on several patients previously receiving thermal treatments to cartilage and have been impressed by the serious lesions left behind. Since I was not present for the index surgery I do not have a reference point as to the original size of the cartilage injury, but I remain impressed with the nonhealing lesions I have debrided and picked.
Although no single treatment is best for these chronic or acute cartilage injuries, it is my opinion that heat therapy on articular cartilage is not in the best interests of our patients. This study shows significant cell death and poor regeneration capacity for the chondrocytes. It adds to the growing body of animal and basic science studies with similar conclusions that are catching up to the clinical enthusiasm that first greeted this new technology. Therefore, I do not recommend this treatment on patient’s articular cartilage. However, I believe thermal energy does have a role in soft tissue management, including coagulation, ablation, and shrinkage.
Dr. Slauterbeck, Associate Professor, Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, is Associate Editor of Sports Medicine Alert.
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