The pulsed holmium: yttrium-aluminum-garnet laser. Applications to ankle arthroscopy

The holmium:YAG laser has many advantages over conventional surgical instrumentation and techniques in ankle arthroscopy. These include minimal mechanical damage to surrounding tissue structures, better access to tight recesses, and the ability to coagulate, smooth, ablate, and weld tissues. The laser also offers improved contouring of damaged articular surfaces, all with a single instrument. The holmium:YAG laser uses a wavelength of 2.1 microns, which is strongly absorbed by water, the major component of tissue. This wavelength allows the laser to deliver a consistent tissue effect to both pigmented and nonpigmented tissues. It currently may transmit up to 60 watts of power to tissue in high-energy, short-duration pulses. The holmium:YAG laser also operates in a fluid medium, which provides a near physiologic environment and maintains continual irrigation. The holmium:YAG laser beam is transmitted through a flexible fiberoptic handpiece, which greatly increases maneuverability. A variety of angled laser tips are available, depending on the pathology type and location. Different tissue effects can be created by varying the tip to target distance. All these qualities provide precise control without significant thermal damage and make the laser ideal for application to articular structures of the ankle joint. The holmium:YAG laser is a safe and effective arthroscopic instrument with a promising future. We have used it, along with traditional shavers and abraders, to effectively treat numerous pathologies of the ankle joint. The laser's versatility in cutting, ablation, and coagulation has been uniformly successful. Patients surveyed postoperatively have reported less overall symptoms and faster healing. They have reported a decrease in ecchymosis, edema, and postoperative pain. Patients' return to full activity has appeared to be quicker with the use of holmium:YAG laser therapy. Although our results have thus far been very encouraging, further research and clinical applications in the use of the holmium:YAG laser need to be continued.