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[Arthroscopic meniscectomy with Ho-Yag laser versus mechanical meniscectomy. Mid-term results of a randomized prospective study of 80 meniscectomies].

INTRODUCTION
The theoretical advantages of the Ho-Yag laser make it the ideal instrument for current use in arthroscopic meniscectomy. Short term results 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 mechanically 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 with a mean follow up of 19.5 months (extremes 12-35 months). The mean age was 42.5 years (extremes 18-65 years). The laser group included 39 patients while 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: Pain and Lysholm score assessment. This was repeated in the post operative period at the 10th, 30th day and at last follow up. 37 patients also had a standard X ray at last follow up (anterior-posterior, lateral, and schuss views).


RESULTS
No statistically significant difference was observed in global clinical results between both techniques. Even if mechanical meniscectomy showed better results, the laser remained best when used in degenerative medial meniscal tears with minimal cartilaginous lesions. In degenerative medial meniscal tears with severe cartilaginous lesions, mechanical meniscectomy showed 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 joint space was observed in 45 p. 100 of laser group and in 18 p. 100 of mechanical group. Iterative arthroscopy was necessary in 4 cases (3 laser and 1 mechanical) for residual pain. Severe chondrolysis was present in 2 cases following laser meniscectomy. In the 2 other cases a complement of meniscectomy 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 arthroscopic meniscectomy.