Lasers in orthopedic surgery.

Among surgical specialities; orthopedics has been the slowest to embrace the laser as a surgical tool. Although lasers have been used in ophthalmology for over two decades, and laser usage has become commonplace in gynecology, otorhinolaryngology, dermatology, plastic surgery, and general surgery, it is only within the past four years that lasers have attracted appreciable attention in orthopedics. The fact that much of the surgery in the majority of specialities is ablative in nature makes use of the laser particularly appealing, as lasers are the ultimate of ablative tools. Much of orthopedic surgery, on the other hand, is primarily reparative or reconstructive in nature. The re-establishment of continuity or the replacement of tissues such as bone, tendon, and ligament are the goals of the majority of orthopedic surgical procedures. While lasers may ultimately play some role in tissue repair, that role is currently viewed as one of providing precision (for example, nerve and small vessel "welding") rather than strength, the latter being crucial in orthopedics. It is, thus, not surprising that the interest in "orthopedic lasers" centers around the relatively few procedures that are ablative in nature - intervetebral disc removal, the removal of polymethylmethacrylate, and the majority of arthroscopic procedures.