Lasers, Microwaves, and Orthopaedic Surgery: Electromagnetic Devices for the Modern Surgeon

Robert C. Schenck, Jr, MD

Disclosures

Medscape Orthopaedics & Sports Medicine eJourn. 2001;5(4) 

In This Article

Summary: Implications for Clinical Practice

1. Laser technology in arthroscopy and management of disc-related low back pain has in large part been replaced by RF devices and technology. Cost of equipment, lack of temperature control, and soft-tissue depth contribute to the lack of clinical efficacy of current laser technology.

2. RF treatment of lumbar disc disease and annular tears is very early in its development. Although it is an exciting, new, minimally invasive approach to the management of low back pain, it requires greater experience and study, and, in my opinion, should be looked at with a healthy degree of skepticism until indications and patient outcomes are clearly defined.

3. RF technology in arthroscopy is becoming a significant adjunct for soft-tissue debridement with "ablation" in both the knee and shoulder. Soft-tissue debridement (ablation) allows for an aid to the technical exercise of arthroscopic acromioplasty in the shoulder and arthroscopic notchplasty in reconstruction of the ACL-deficient knee. Nonablative treatment in the shrinkage of the shoulder and knee capsule (medial patellofemoral ligament) and knee cruciate ligaments is still to be defined, and both successes and failures are recorded in the literature. In my experience, capsular shrinkage in the management of shoulder instability is a useful adjunct for properly indicated procedures. Nonablative RF treatment of articular defects causes chondrocyte death and is not recommended. ROM after shrinkage procedures is surgeon- and procedure-dependent, and product/device guidelines should be tempered with clinical experience.

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