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The knee op that helps free the knees up

January 20, 2000

Most people over the age of 30 have some sort of problem with their knees making walking, running or playing sport uncomfortable, and thousands of people each year have surgery to remove damaged cartilage from within their knees.

New research published today (24 January) in the journal Physics in Medicine and Biology, from the Institute of Physics, describes a novel laser system that could help surgeons perform the minimal level of surgery needed to produce an optimal result.

Sandwiched in the centre of the knee joint are two crescent-shaped wedges of cartilage - meniscal cartilage. Their function is to act as shock absorbers and allow the hinge-like joint to move freely. However, bending the knee becomes painful if this cartilage is torn or damaged. Surgeons then operate to remove the offending part of the cartilage. Dr Marta Dark and colleagues, of the Laser Biomedical Research Center, G.R. Harrison Spectroscopy Laboratory, in the Massachusetts Institute of Technology (MIT), Cambridge, USA, have developed an ultra violet laser system capable of distinguishing between healthy and degenerated cartilage

"We can measure how far the light travels into the tissue, which indicates how much protein and water are present. This shows how healthy the tissue is because if the cartilage is damaged, protein breaks down and water accumulates. We can also use the laser to measure the elastic properties and the tensile strength of the tissue," explains Dr Dark.

Dr Dark studied cartilage that had been removed during operations in Bridham and Womens Hospital, Harvard Medical School MIT. Surgeon Jonathan Schaffer believes that during an operation, laser light can be shined onto cartilage inside the knee by using an optical fibre. The fibre would pass through the hole drilled by the surgeon during keyhole surgery. The surgeon could then decide which bits of the cartilage need removing and thus leave as much healthy tissue behind as possible.

Schaffer adds that most knee surgery is performed by 'keyhole' techniques, so an advance in this field could find wide use.

"The most novel part of the system is the interferometer that allowed us to determine the speed and direction that the surface of the cartilage was moving when it was struck by the laser light. We could operate at nanosecond and nanometre levels of accuracy," says Dr Dark.

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