[Use of lasers in arthroscopy]

Arthroscopic surgery has become a routine procedure, thanks to the availability of excellent video systems and the development of new and efficient instruments. Since early 1980 several groups have been developing arthroscopic laser surgery. Laser technology is ideal for use in endoscopic surgery because lasers are potentially extremely small but nevertheless powerful tools with many advantages. Initially, attempts were made to modify CO2 lasers an Nd: YAG lasers for arthroscopic surgery, since these devices were readily available in many hospitals, but they proved unsuitable for arthroscopy. Clear definition of the desired goals and much experimentation eventually led to the development of three suitable systems: excimer, holmium: YAG and erbium: YAG lasers. After extensive investigation in the past few years, many groups have, for technical reasons, now opted for the holmium: YAG-laser as the best compromise. Lasers are used in arthroscopy not only to divide tissue but also to smoothen cartilage, for hemostasis, for percutaneous lumbar and cervical disc surgery, for photodynamic therapy, for tumor therapy and in diagnosis. The threshold to clinical practice in orthopedic laser surgery has now been crossed. Lasers must now show, in prospective clinical studies, that their theoretical advantages are matched in practice.