The purpose of this study was to evaluate the effect of laser energy at nonablative levels on joint capsular histologic and biochemical properties in an in vitro rabbit model. The medial and lateral portions of the femoropatellar joint capsule from both stifles of 12 mature New Zealand White rabbits were used. Speci mens were divided into three treatment groups (5 watts, 10 watts, and 15 watts) and one control group using a randomized block design. Specimens were placed in a 37° bath of lactated Ringer's solution and laser energy was applied using a holmium:yttrium-alu minum-garnet laser in four transverse passes across the tissue at a velocity of 2 mm/sec with the handpiece set 1.5 mm from the synovial surface. Histologic anal ysis revealed thermal alteration of collagen (fusion) and fibroblasts (pyknosis) at all energy densities, with higher laser energy causing significantly greater mor phologic changes over a larger area (P < 0.05). Ap plication of laser energy did not significantly alter the biochemical parameters evaluated, including type I col lagen content and nonreducible crosslinks (P > 0.05). This study demonstrated that nonablative laser energy caused significant thermal damage to the joint capsular tissue in an energy-dependent fashion, but type I col lagen content and nonreducible crosslinks were not significantly altered.
Get full access to this article
View all access options for this article.
References
1.
Allain JC, Le Lous M., Cohen-Solal L., et al Isometric tension developed during the hydrothermal swelling of rat skin. Connect Tissue Res7: 127-133, 1980
2.
Altchek DW Shoulder instability in the throwing athlete Sports Med Arthroscopy Rev1210-216, 1993
3.
Altchek DW, Warren RF, Skyhar MJ, et al T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types J Bone Joint Surg73A 105-112, 1991
4.
Bass LS, Moazami N., Pocsidio J., et al: Changes in type I collagen following laser welding Lasers Surg Med12500-505, 1992
5.
Brems JJ, Bergfeld J. Multidirectional shoulder instability Orthop Trans1584, 1991
6.
Bruckner P., Prockop DJ Proteolytic enzymes as probes for the triple-helical conformation of procollagen Anal Biochem110360-368, 1981
7.
Burkhead WZ, Rockwood CA Jr Treatment of instability of the shoulder with an exercise program J Bone Joint Surg74A: 890-896, 1992
Duffy S., Davis M., Sharp F., et al: Preliminary observations of Holmium YAG laser tissue interaction using human uterus Lasers Surg Med12: 147-152, 1992
10.
Dunphy MJ, Bhide MV, Smith DJ: Determination of hydroxyproline in tissue collagen hydrolysate by derivatization and isocratic reverse-phase high-performance liquid chromatography J Chromatogr420: 394-397, 1987
11.
Emery Rjh, Mullaji AB Glenohumeral joint instability in normal adolescents: Incidence and significance . J Bone Joint Surg73B: 406-408, 1991
12.
Eyre DR, Koob TJ, Van Ness KP Quantitation of hydroxypyridinium crosslinks in collagen by high-performance liquid chromatography Anal Biochem137380-388, 1984
13.
Finch A., Ledward DA Shrinkage of collagen fibres A differential scanning calorimetric study Biochim Biophys Acta278433-439, 1972
14.
Flint MH, Lyons MF The effect of heating and denaturation on the staining of collagen by the Masson trichrome procedure Histochem J7547-555, 1975
15.
Flory PJ, Garrett RR: Phase transition in collagen and gelatin systems J Am Chem Soc804836-4845, 1958
16.
Flory PJ, Spurr OK Melting equilibrium for collagen fibers under stress Elasticity in the amorphous state J Am Chem Soc83: 1308-1316, 1960
17.
Flory PJ, Weaver ES Helix coil transition in dilute aqueous collagen solutions J Am Chem Soc824518-4525, 1959
18.
Gee G.: Some thermodynamic properties of high polymers, and their molecular interpretation Quart Rev1265-298, 1947
19.
Gorisch W., Boergen KP Heat-induced contraction of blood vessels. Lasers Surg Med2: 1-13, 1982
20.
Gosselin LE , Martinez DA, Vailas AC, et al: Interstitial space and collagen alterations of the developing rat diaphragm J Appl Physiol742450-2455, 1993
Guthrie CR, Murray LW, Kopchok GE, et al Biochemical mechanisms of laser vascular tissue fusion. J Invest Surg43-12, 1991
23.
Haly AR, Snaith JW Calorimetry of rat tail tendon collagen before and after denaturation. The heat of fusion of its absorbed water. Biopolymers101681-1699,1971
24.
Hayashi K., Markel MD, Thabit G. III, et al The effect of nonablative laser energy on joint capsular properties. An in vitro mechanical study using a rabbit model Am J Sports Med23482-487, 1995
25.
Horgan DJ, King NL, Kurth LB, et al Collagen crosslinks and their relationships to the thermal properties of calf tendons Arch Biochem Biophys28121-26, 1990
26.
Jobe FW, Giangarra CE, Kvitne RS, et al Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports Am J Sports Med19428-434, 1991
27.
Kleftogiannis F., Handley CJ, Campbell MA Characterization of extracellular matrix macromolecules from bovine synovial capsule J Orthop Res12. 365-374, 1994
28.
Kostolich M. , Bartels KE, Schafer SA, et al Ho YAG laser ablation of alimentary tract mucosa. The Society of Photo-Optical Instrumentation Engineers188074-81, 1993
29.
Lebar RD, Alexander AH Multidirection shoulder instability Clinical results of inferior capsular shift in an active-duty population Am J Sports Med20193-198, 1992
30.
LeCarpentier GL, Motamedi M., McMath LP, et al Continuous wave laser ablation of tissue Analysis of thermal and mechanical events IEEE Trans Biomed Eng40: 188-200, 1993
31.
Lim JJ Transition temperature and enthalpy change dependence on stabilizing and destabilizing ions in the helix-coil transition in native tendon collagen Biopolymers152371-2383, 1976
32.
Markel MD The power of a statistical test What does insignificance mean? Vet Surg20209-214, 1991
33.
Moreira H., Campos M., Sawusch MR, et al. Holmium laser thermokeratoplasty Ophthalmology100752-761, 1993
34.
Murray LW, Su L., Kopchok GE, et al Crosslinking of extracellular matrix proteins A preliminary report on a possible mechanism of argon laser welding Lasers Surg Med9490-496, 1989
35.
O'Bnen SJ, Miller DV The contact neodymium-yttrium aluminum garnet laser A new approach to arthroscopic laser surgery Clin Orthop25295-100, 1990
36.
Oz MC, Bass LS, Popp HW, et al In vitro comparison of thulium-holmium-chromium YAG and argon ion lasers for welding biliary tissue Lasers Surg Med9248-253, 1989
37.
Pearce JA, Thomsen S. Kinetic models of laser-tissue fusion processes Biomed Sci Instrum29355-360, 1993
38.
Pollock RG, Bigliani LU Glenohumeral instability: Evaluation and treatment J Am Acad Orthop Surg124-32, 1993
39.
Rabau MY, Wasserman I., Shoshan S. Healing process of laser-welded intestinal anastomosis Lasers Surg Med1413-17, 1994
40.
Rigby BJ The effect of mechanical extension upon the thermal stability of collagen Biochim Biophys Acta79634-636, 1964
41.
Schober R., Ulrich F., Sander T., et al. Laser-induced alteration of collagen substructure allows microsurgical welding Science2321421-1422, 1986
42.
Sherk HH The use of lasers in orthopaedic procedures J Bone Joint Surg75A 768-776, 1993
43.
Steiner D., Hermann B. Collagen fiber arrangement of human shoulder joint capsule—An anatomical study Acta Anat (Basel) 136300-302, 1989
44.
Thabit G. Treatment of unidirectional and multidirectional glenohumeral instability by an arthroscopic holmium YAG laser-assisted capsular shift procedure—A pilot study, in Laser Application m Arthroscopy Neuchatel, Switzerland, The International Musculoskeletal Laser Society, 1994
45.
Trauner K., Nishioka N., Patel D. Pulsed holmium yttrium-aluminum garnet (Ho YAG) laser ablation of fibrocartilage and articular cartilage Am J Sports Med18316-320, 1990
46.
Verzar F., Nagy IZ Electronmicroscopic analysis of thermal collagen denaturation in rat tail tendons Gerontologia1677-82, 1970
47.
Warner JP, Marks PH Management of complications of surgery for anterior shoulder instability Sports Med Arthroscopy Rev1272-292, 1993
48.
Young DC, Rockwood CA Jr Complications of failed Bristow procedure and their management J Bone Joint Surg73A 969-981, 1991
