Arthroscopic shoulder surgery with three different laser systems: an evaluation of laser applications

Twelve cadaveric shoulder arthroscopies were performed to evaluate the use of lasers as an adjunctive tool in arthroscopic shoulder surgery. The three most common lasers historically used in orthopedic surgery were examined: Holmium:YAG, Neodymium:YAG, and the CO2. The following parameters were evaluated for each laser system: (1) ease of use of the laser system and handpiece; (2) ability to excise and trim bursae, synovium, ligament, tendon, bone, and articular cartilage; and (3) ability to contract ligaments and capsule by heat transfer. None of these lasers efficiently cut bone, whereas all three systems readily debrided the soft tissues around the shoulder. The free-beam Ho:YAG and CO2 systems heat contracted soft tissues with more control than the contact Nd:YAG. The fiberoptic delivery system of the Neodymium:YAG and Holmium:YAG laser performed well in the saline arthroscopy, and the CO2 delivery system was cumbersome. Overall, the CO2 system removed tissue better than the others, but its difficult use favored the Holmium laser as the best overall current laser system for shoulder arthroscopy.