Laser induced removal of meniscus cartilage and tendines

Mid-IR laser ablation of articular and fibro-cartilage: a wavelength dependence study of thermal injury and crater morphology

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate areas of collateral thermal injury and crater morphology for evidence of wavelength-dependent effects on the ablation of articular cartilage and fibro-cartilage (meniscus) using selected mid-IR wavelengths produced by a free electron laser.

STUDY DESIGN/MATERIALS AND METHODS

Two types of cartilage, articular cartilage and fibro-cartilage were used in the study. The wavelengths (lambda) evaluated were 2.79, 2.9, 6.1, and 6.45 microm generated by a free electron laser (FEL) using a 4 microseconds macropulse configuration. The zone of thermal injury and crater morphology produced by laser ablation were examined by light microscopy following standard histologic processing.

RESULTS

The zone of thermal injury and crater morphology created in cartilage by the FEL at selected mid-IR wavelengths were examined as a function of incident radiant exposure. Ablation using lambda = 6.1 microm provided the largest crater size for both articular and fibro-cartilage at all radiant exposures. For the zones of collateral thermal injury in articular cartilage, lambda = 6.1 microm produced the least thermal injury at the radiant exposure of 7.6 J/cm2. When the radiant exposure is increased to 20.4 J/cm2, both lambda = 6.1 and 6.45 microm produced less thermal injury than the ablation using lambda = 2.79 and 2.9 microm. The greatest amount of collateral thermal injury was produced by lambda = 2.79 microm for both tissue types.

CONCLUSIONS

The results demonstrate that crater depth and collateral thermal injury produced in articular cartilage and fibro-cartilage are wavelength-dependent with 6.1 microm providing the largest craters at all radiant exposures. The least amount of thermal injury was created in articular cartilage using lambda = 6.1 microm at the radiant exposure of 7.6 J/cm2. Both 6.1 and 6.45 microm wavelengths demonstrated similar amount of thermal injury at 20 J/cm2 that was less than lambda = 2.79 and 2.9 microm at similar fluences. These observations are explained based on the absorption by water and protein in the tissue types studied. It is further observed that the use of crater dimensions may not provide a reliable estimate for the amount of tissue removal provided by an ablation procedure.

Free electron laser ablation of articular and fibro-cartilage at 2.79, 2.9, 6.1, and 6.45 ?m: Mass removal studies

BACKGROUND AND OBJECTIVE

The wavelength and tissue-composition dependence of cartilage ablation was examined using selected mid-infrared laser wavelengths.

STUDY DESIGN/MATERIALS AND METHODS

The mass removal produced by pulsed laser ablation of articular and fibro-cartilage (meniscus) were measured. The wavelengths examined were 2.79, 2.9, 6.1, and 6.45 microm and provided by a free electron laser (FEL) emitting 4 microsecond macropulses consisting of 1-2 picoseconds duration micropulses delivered at 350 picosecond intervals. The measurement of tissue mass removal was conducted using a microbalance during laser ablation.

RESULTS

These studies demonstrated that for articular cartilage the highest mass removal was achieved at lambda = 6.1 microm followed by, in order, lambda = 2.79, 2.9, and 6.45 microm. In comparison, the maximum mass removal for fibro-cartilage was achieved using lambda = 6.1 microm radiation with no statistically significant differences in mass removal provided by the other wavelengths. In evaluation of the comparative influence of each wavelength on tissue type, there was no difference in ablation efficiency between articular and fibro-cartilage at lambda = 6.1 microm. However, the ablation efficiency of articular cartilage was higher than that of fibro-cartilage at both lambda = 2.79 and 2.9 microm. By contrast, lambda = 6.45 microm radiation ablated fibro-cartilage more efficiently than articular cartilage at radiant exposures greater than 12 J/cm2.

CONCLUSIONS

The mass removal of articular and fibro-cartilage produced by FEL ablation at selected mid-IR wavelengths was measured as a function of incident radiant exposure. The ablation efficiency was found to depend on both wavelength and tissue type. The 6.1 microm wavelength was found to provide the highest ablation efficiency for both articular and fibro-cartilage.

Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects

OBJECTIVE

To review the basic scientific status of repair in articular cartilage tissue and to assess the efficiency of current clinical therapies instigated for the treatment of structural lesions generated therein as a result of trauma or during the course of various diseases, notably osteoarthritis (OA). Current scientific trends and possible directions for the future will also be discussed.

DESIGN

A systematic and critical analysis is undertaken, beginning with a description of the spontaneous repair responses in different types of lesion. Surgical interventions aimed at inducing repair without the use of active biologics will then be considered, followed by those involving active biologics and those drawing on autogenic and allogeneic tissue transplantation principles. Cell transplantation approaches, in particular novel tissue engineering concepts, will be critically presented. These will include growth-factor-based biological treatments and gene transfection protocols. A number of technical problems associated with repair interventions, such as tissue integration, tissue retention and the role of mechanical factors, will also be analysed.

RESULTS

A critical analysis of the literature reveals the existence of many novel and very promising biologically-based approaches for the induction of articular cartilage repair, the vast majority of which are still at an experimental phase of development. But prospective, double-blinded clinical trials comparing currently practiced surgical treatments have, unfortunately, not been undertaken.

CONCLUSION

The existence of many new and encouraging biological approaches to cartilage repair justifies the future investment of time and money in this research area, particularly given the extremely high socio-economic importance of such therapeutic strategies in the prevention and treatment of these common joint diseases and traumas. Clinical epidemiological and prospective trials are, moreover, urgently needed for an objective, scientific appraisal of current therapies and future novel approaches.