The use of meniscus perforation with a two–wave fiber laser device LSP - "IRE-Polus" (NTO "IRE-Polus", Russia) during arthroscopic suture

Introduction: Suturing the damaged parts of the meniscus through arthroscopic access is the only method of meniscus preservation. However, it does not always fuse. And this is the problem that we were interested in and prompted us to address it. Laser technology shows good results in various studies, and this served as a basis for the first stage of experimental work. We applied the laser technique, namely microperforation, on explants.

Purpose: To evaluate the result of experimental work of laser perforation by two-wave fiber laser device LSP - "IRE-Polus" (NTO "IRE-Polus", Russia) on meniscus explants in order to assess the use of laser technology in combination with arthroscopic suture of the knee joint meniscus to improve the treatment results.

Methods: Fragments of meniscus tissue extracted during surgical intervention of knee joint endoprosthesis were taken, laser processing was performed, followed by histologic examination.

Results: From all three investigated parameters of laser radiation exposure on meniscus tissue the mode of pulse-periodic exposure with a wavelength of 0.97 microns, power - 15 W at the input, wavelength of 1.56 microns power - 2 W at the output is the most optimal. At these parameters the focus of laser influence has the smallest diameter. There were no signs of coagulation and carbonization in the edges of the laser exposure focus. There was practically no edema of fiber bundles and fibers both at the periphery of the focus of laser exposure and in the nearest, adjacent areas, i.e., there was no mediated reaction. With this parameter of laser exposure, we were able to achieve a localized effect.

Conclusion: on the basis of histologic analysis, we came to the conclusion that the method is effective. The study of the combination of arthroscopic suture and laser perforation of meniscus injuries in comparison with the methods of mechanical traumatization (treatment with a shaver, rasp) and the influence of this method on cell proliferation and blood supply in the meniscus tear zone due to meniscus perforation requires further investigation in the clinical stage.

1. Brindle T, Nyland J, Johnson DL. The meniscus: review of basic principles with application to surgery and rehabilitation. J Athl Train. 2001;36(2):160-169.

2. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach. World J Orthop. 2014;5(3):233-241. Published 2014 Jul 18. doi:10.5312/wjo.v5.i3.233

3. Jarraya M, Roemer FW, Englund M, et al. Meniscus morphology: Does tear type matter? A narrative review with focus on relevance for osteoarthritis research. Semin Arthritis Rheum. 2017;46(5):552-561. doi:10.1016/j.semarthrit.2016.11.005

4. Kozlowski EJ, Barcia AM, Tokish JM. Meniscus repair: the role of accelerated rehabilitation in return to sport. Sports Med Arthrosc Rev. 2012;20(2):121-126. doi:10.1097/JSA.0b013e318253d7c6

5. Fox AJ, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat. 2015;28(2):269-287. doi:10.1002/ca.22456

6. Klimkiewicz JJ, Shaffer B. Meniscal surgery 2002 update: indications and techniques for resection, repair, regeneration, and replacement. Arthroscopy. 2002;18(9 Suppl 2):14-25. doi:10.1053/jars.2002.36505

7. Voloshin AS, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng. 1983;5(2):157-161. doi:10.1016/0141-5425(83)90036-5

8. Weinstabl R, Muellner T, Vécsei V, Kainberger F, Kramer M. Economic considerations for the diagnosis and therapy of meniscal lesions: can magnetic resonance imaging help reduce the expense?. World J Surg. 1997;21(4):363-368. doi:10.1007/pl00012254

9. Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(5):733-739. doi:10.1016/j.apmr.2011.08.049

10. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Ann Rheum Dis. 2018;77(2):188-195. doi:10.1136/annrheumdis-2017-211172

11. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. Br J Sports Med. 2015;49(19):1229-1235. doi:10.1136/bjsports-2015-h2747rep

12. Logerstedt DS, Scalzitti DA, Bennell KL, et al. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. J Orthop Sports Phys Ther. 2018;48(2):A1-A50. doi:10.2519/jospt.2018.0301

13. DeHaven KE, Arnoczky SP. Meniscus repair: basic science, indications for repair, and open repair. Instr Course Lect. 1994;43:65-76.

14. Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg. 2002;10(3):168-176. doi:10.5435/00124635-200205000-00003

15. Horibe S, Shino K, Nakata K, Maeda A, Nakamura N, Matsumoto N. Second-look arthroscopy aſter meniscal repair. Review of 132 menisci repaired by an arthroscopic inside-out technique. J Bone Joint Surg Br. 1995;77(2):245-249.

16. Zhang Z, Arnold JA. Trephination and suturing of avascular meniscal tears: a clinical study of the trephination procedure. Arthroscopy. 1996;12(6):726-731. doi:10.1016/s0749-8063(96)90178-4

17. Petersen W, Tillmann B. Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl). 1998;197(4):317-324. doi:10.1007/s004290050141

18. Laible C, Stein DA, Kiridly DN. Meniscal repair. J Am Acad Orthop Surg. 2013;21(4):204-213. doi:10.5435/JAAOS-21-04-204

19. Austin KS, Sherman OH. Complications of arthroscopic meniscal repair. Am J Sports Med. 1993;21(6):864-869. doi:10.1177/036354659302100619

20. Siebold R, Dehler C, Boes L, Ellermann A. Arthroscopic all-inside repair using the Meniscus Arrow: long-term clinical follow-up of 113 patients. Arthroscopy. 2007;23(4):394-399. doi:10.1016/j.arthro.2006.11.027