“Laser in Orthopedic

Surgery”
(Part-3)
Interaction and effects of laser
(UV-IR) radiation on biological
tissue
and its uses in Orthopedic
Surgery.
Presented by-
Dr. Md Nazrul Islam.
Assistant Registrar, Orthopedic and
traumatology
Department, Shaheed Suhrawardy
 Laser :
Alternative/ Adjuventive

Over 2,500 scientific studies in the National

Library of Medicine have identified the many
benefits of laser therapy as an alterative to
surgical intervention for pain.

Laser therapy does not require the use of

drugs or invasive treatment; there are
fewer side effects and risks, and it is quick,
painless, and convenient.

It can be adjuventive to other modalities of

treatment like- medication, surgery or other
therapeutic approach.
Laser
Interaction
with
Biological Tissues:
 Types of laser, based on
Effectiveness:

a. Biostimulative Laser
b. Bioinhibiting Laser.
a. Biostimulative Laser:
Laser is biostimulative effect on
bioligical tissues,
when it is used in a targeted tissue with
specific wavelength. Different
biological tissue is responsive to different
wavelength.

b. Bioinhibiting Laser:
Laser has bioinhibitory effect when it
is used with inappropriate wavelength,
that means laser can be harmful to
Types of laser, based on power:
a. Low power Laser
b. High power Laser
Low power Laser: It has long wavelength,
anabolic effects, and it promote rapid
reduction of pain, accelerates healing time/
growth and reduce repair stage of healing:
on the other hand don't give of heat use
photo energy.

High power laser: they have shorter

wavelengths which have catabolic effects
that can deliberately destroy tissue in
cauterizing and surgical applications, are
used to through tissue and give off heat.
Interaction of laser on
biologic tissues

Scattering
Penetration
Absorption

Electromagnetic radiation in
the UV-IR spectral range
propagates into biologic tissues
until it is either scattered or
absorbed.
Interaction of laser with biologic
tissue
Interaction of laser with biologic
tissue
Interaction of laser on biologic
tissues
Interaction of laser on biologic
tissues
 Scattering of laser into
biologic tissue

Scattering occurs at the boundaries

between regions having different optical
refractive indices because of
inhomogeniusness that is-

a. Water
b. Biomolecule (Protein, lipid etc.)
c. Pigments in the tissue.
Penetration of laser into
biologic tissue

Penetration of laser in the

biological tissues is
supposed to be occurred in
an exponential decrease
(Bears Law) if there had
been no scattering or
absorption.
Absorption of laser into
biologic tissue
Laser absorption in biological
tissues
( In IR-UV region of medical
interest) predominantly depends
on wavelength.
The absorption of laser is highest
in water molecule.
Protein, Pigments and Melanin
has different absorption
coefficient depending their
molecular structure.
Absorption of laser into
biologic tissue
Absorption of laser into biologic
tissue
 Absorption of laser into
biologic tissue

Absorbed energy from laser

releases from water/
biomolecule by-
Fluorescence
Resonant electronic energy
transfer
and
Thermal vibration.
Application of Fluorescence
effect of laser:

Laser-induced fluorescence
(LIF) is a spectroscopic method
used for studying structure of
molecules, detection of
selective species and flow
visualization and measurement.
 Resonant electronic energy
transfer.

Resonance energy transfer (RET)

or electronic energy transfer (EET),
is a mechanism describing energy
transfer between two
chromospheres.

FRET has been applied in an

experimental method for the
detection of phosgene.
 Application of absorption
effects of laser:

Thermal Heating of tissues has two

effects -
– Coagulation/cauterizing of tissues,
– Tissue vaporization for incising or
excising.

Ionizing Ablation of the molecules

in the target tissue.
This form of photodisruption is used
primarily in ophthalmic / Orthopedic
practice.

Phototherapy Photochemical effects

include photoablation, photodynamic
therapy (necrosis of tumors in
cancer), and photoradiation to
enhance wound
healing.
Stages of tissue healing by
laser therapy:

Haemostasis; the arrest of bleeding by

involving the physiological processes of
blood coagulation and contraction of
blood vessels. Haemostasis lasts several
minutes.
Inflammatory phase; triggers
neutrophils and macrophage migration
into the wound. This phase lasts several
days.
Stages of tissue healing by laser
therapy: (Continues)

Granulation; the formation of a

multicellular mass of tissue which can
last up to three weeks.
Re-epithelization; basement proteins
reappear in a very ordered sequence
from the wound inward in a zipper like-
fashion closing the epidermal defect.
Wound contraction and tissue
remodeling; growth factors and other
peptides provide stimuli for wound
contraction.
Laser
application in
Tissues:
General view-
 Laser Therapy
promotes

Improved circulation
Improved nerve function
Accelerated tissue repair
Increased mobility and muscle
function
Laser Therapy helps

Reduce inflammation
Decrease swelling
Heal soft tissue injuries
Diminish or eliminate acute pain
Reduce chronic pain and
discomfort
 Laser Therapy
successfully treats

Acute and chronic pain

Arthritis (osteoarthritis and rheumatoid
arthritis)
Soft tissue injuries, including sprains
and strains
Tendonitis and bursitis
Muscle spasm and tension
Vertebral disc conditions
Sciatica, neuralgia, fibromyalgia
Post operative orthopedic, implants,
fractures
Swelling and edema
Post-Operative Healing
Clinical studies have shown that laser therapy is
especially beneficial for post-op patients. It works
to accelerate tissue repair and cell growth, heal
wounds faster, reduce the formation of scar
tissue, reduce swelling and pain, improve
vascular and metabolic activity and boosts the
function of the immune system.

The energy produced by the laser stimulates the

production of collagen and ATP (a DNA-related
enzyme that serves as a source of energy to
cells), promotes blood circulation, and stimulates
the regeneration of nerves. The non-invasive
treatment speeds recovery and accelerates bone
and wound healing, which means significantly
less down time for the patient.
 Advantages of laser
surgery vs. traditional
surgery?

Most laser surgeries can be performed

on an outpatient basis.
Very small / precise incision.
No damage to surrounding areas
Less bleeding /"bloodless surgery," ,
and less swelling.
Less time consuming procedure.
Lower rate of local infections.
Reduce post-operative pain.
Reduce post operative recovery period.
 Disadvantages of laser
surgery vs. traditional surgery?

Cost.
Eye hazards.
Imprecisely aimed lasers can burn or
destroy healthy tissue.
Needs special training/ arrangement.
Cardiopulmonary resuscitation (CPR)
arrangement is recommended to avoid/
manage electrical incidence.
 Risks

Like traditional surgery, laser

Surgery can be complicated
by:
Hemorrhage
Infection
Perforation (piercing) of an
organ or tissue.
Diagrammatic comparison graph to show muscle healing by
laser therapy, to non-laser treated patients, assessing

creatinine kinase level.

 Laser
application
in Orthopedics:
 Application of laser in
orthopedic surgery:

Musculoskeletal
Wound Healing
Nerve Regeneration

f. To reduce pain.
g. To reduce inflammation
h. Increased tissue tensile
strength
i. Increased collagen production
j. To enhance and reduce healing
time.
k. In surgical procedure.
 Application of laser in
orthopedic surgery: Pain
Management:

• Fibromyalgia
• Myofascial pain
• Cervical neck pain
• Low back pain
• Joint pain
• Trigeminal neuralgia
Application of laser in orthopedic
surgery: Inflammatory Conditions:

• Rheumatoid Arthritis
• Carpal Tunnel Syndrome
• Tendonitis
• Plantar fasciitis
• Bursitis
 Application of laser in
orthopedic surgery:
Connective Tissue Injury /
Disorders:

• Sprains
• Strains
• Tendonitis
• Tendon ruptures
Application of laser in orthopedic
surgery: Joint Injuries /
Disorders:

• TMJ disorders
• Osteoarthritis
• Dislocations
• Ligament injury
Application of laser in orthopedic
surgery:
Muscle Injuries / Disorders:

• Muscle bruises, contusions

• Muscle ruptures
• Muscle trigger points.
 Application of laser in
orthopedic surgery:
Neurological injury / disorders:

• Prolapsed disk
• Ruptured disk
• Crush injuries
• Neuritis
• Trigeminal neuralgia
• Tinnitus
Application of laser in orthopedic
surgery: Skin injuries / conditions:

• Surgical incisions
• Skin ulcers
• Burns
• Skin grafts
 Application of laser in
orthopedic surgery: Diagnostic-

Arthroscopy.
Bony tissue Biopsy.
Angioplasty
Tumor imaging and visualization
Selective caries removal
Blood flow cytometry
Laser induced fluorescence imaging
Photoacoustic imaging
TMR
 Application of laser in
Orthopedic
Surgery:
Therapeutic
Therapeutic
nonoperative-

Physiotherapy
Degenerative Conditions:
Rheumatoid Arthritis
Osteoarthritis
Soft Tissue Injuries:
Arthritis Pain• Tendinitis• Tennis Elbow•
Acute Pain • Chronic Pain • Wound Healing•
Carpal Tunnel• Strains/ Sprains• Frozen
Shoulder• Plantar Fasciitis• Fibromyalgia •
Knee Pain• Neck & Back Pain• Whiplash
Application of laser in Orthopedic
Surgery:
Therapeutic

Therapeutic
operative-

Reconstructive surgery: knee

Spine surgery: PLDD
Removal of soft tissue mass.
Amputation:
Biopsy: Bone/Soft tissue.
Important parameters

Laser parameters : Wavelength,

Power density, exposure time,
pulse duration, focused spot size,
repetition rate.
Optical properties of the tissue
:absorption and scattering
coefficients
Thermal properties of the tissue:
thermal capacity and thermal
conductivity.
 Thanks
every one for
patience,

Bye.
See you next day with-
“Laser in Orthopedic
Surgery”
(Part-4)
Laser on Hard Tissue