Delayed articular cartilage slough: two cases resulting from holmium:YAG laser damage to normal articular cartilage and a review of the literature.

Abstract

We present two cases referred from other physicians with chondral damage and cartilage slough secondary to use of the holmium:YAG laser during knee arthroscopy. The first patient had a partial lateral meniscectomy, which was done with a 20-W Ho:YAG laser. The patient never fully recovered and underwent a second arthroscopy that revealed full-thickness cartilage defects of the lateral femoral condyle. The second patient had debridement of Outerbridge grade III changes of the lateral tibial plateau and patella, as well as a partial lateral meniscectomy using a Ho:YAG laser. The patient developed recurrent symptoms, and when a second arthroscopy was performed, new degenerative changes to the lateral femoral condyle were noted with large areas of cartilage loss. A careful look needs to be taken at the limited use of lasers until further randomized prospective studies are carried out comparing patient outcomes, cost, and long-term complications.