Combined Monopolar Radiofrequency and Targeted Pressure Energy for the Treatment and Improvement of Cellulite Appearance on Multiple Body Parts.

Background: With many treatments available for managing cellulite, non-invasive procedures are increasingly sought after. Radiofrequency (RF) and targeted pressure energy (TPE) are new techniques developed to counter aesthetic signs of aging. The combination of RF and TPE for cellulite thus requires a more robust investigation. Objective: We sought to determine the effectiveness and safety of combined/simultaneous RF and TPE for skin tightening and reducing the appearance of cellulite. Methods: Thirty subjects aged 46.5±9.0 (31-74) years, BMI 19.8-36kg/m2 were enrolled and treated for cellulite on the hips, thighs, abdomen and arms. Each subject received four treatments, over 2 to 4 consecutive weeks. The circumference of the treated areas was measured at baseline, after the final treatment session, and at follow-up visits one month, three months and six months following treatment. The efficacy of the therapy was evaluated based on the Cellulite Severity Scale, Global Aesthetic Index Scale, and the Subject Satisfaction Questionnaire. Occurrence of side effects and adverse events was monitored, therapy comfort was analyzed. Results: Cellulite severity improved from moderate to mild cellulite (p<0.001) in 95 percent of patients. Blinded, independent, evaluators reported aesthetic improvement in 90 percent of subjects. Significant circumference decrease in the abdomen, hips, and thighs was observed six months after treatment (p<0.01). Eighty-six percent of subjects were satisfied with improved cellulite appearance, and 82 percent of patients reported improved skin laxity. No severe side effects or adverse events occurred. Conclusion: The simultaneous TPE+RF procedure was able to non-invasively improve cellulite appearance in the majority of subjects and may be recommended for skin tightening on various body parts.

Comparison of Open Drainage Versus Closed Catheter Irrigation for Treatment of Suppurative Flexor Tenosynovitis.

BACKGROUND: The purpose of this study was to review the outcomes associated with different surgical treatments in the management of suppurative flexor tenosynovitis (SFT). METHODS: Patients treated by open drainage (OD) through a single incision and closed catheter irrigation (CCI) of the tendon sheath were evaluated from 2003 to 2009 at a single institution. Variables examined included culture results, time to surgery, duration of hospitalization and antibiotic therapy, pain, reoperation, and functional outcomes were recorded. Statistical analyses used included parametric and nonparametric t tests. RESULTS: Twenty-four patients were treated for SFT with a mean follow-up of 3 ± 2 years. There were 13 (100%) males in the OD group compared to 8 (72%) males within the CCI group. Ninety-two percent of patients who underwent OD and 100% who underwent CCI reported none or mild pain. There were no differences between the 2 groups with regard to functional outcome scores. Factors leading to worse functional outcomes included prolonged time to receiving antibiotics and Staphylococcus aureus infection. Smokers required prolonged antibiotic treatment compared to nonsmokers. Accounting for planned returns to the operating room, there was no difference in reoperation rates between the OD or CCI groups. CONCLUSIONS: Surgical treatment of SFT with either OD or CCI resulted in similar outcomes for pain, function, and need for reoperation. Factors that lead to poor outcomes include S aureus culture, prolonged time to antibiotics, and smoking.

Biomechanical and Computed Tomography Analysis of Adjustable Femoral Cortical Fixation Devices for Anterior Cruciate Ligament Reconstruction in a Cadaveric Human Knee Model.

PURPOSE: To evaluate and compare two adjustable femoral cortical suspensory fixation devices used for anterior cruciate ligament reconstruction through a novel, direct computed tomography (CT) analysis metric and biomechanical laxity testing in a matched cadaveric human knee study. METHODS: Anterior cruciate ligament reconstructions with bovine tendon grafts were performed using two adjustable femoral cortical suspensory fixation devices (RigidLoop Adjustable [DePuy Synthes Mitek, Raynham, MA] and TightRope [Arthrex, Naples, FL]) in 12 knees (6 matched pairs). A mechanical testing series was used to determine each knee's laxity in the intact condition. After reconstruction, each specimen was again tested for laxity and also imaged with CT. The laxity testing and CT imaging were then repeated after 1,000 cycles of anteroposterior loading on each knee to compare changes in laxity for the two fixation devices and to visualize changes in button-to-graft distance migration through a three-dimensional CT imaging method. RESULTS: No significant differences were found between the two fixation groups' laxity measures after reconstruction (all P values ≥ .620) or after cycling (all P values ≥ .211) at any flexion angle. In addition, no significant differences were found between the two groups regarding button-to-graft distance migration (P = .773; mean, 0.61 ± 0.6 mm [95% confidence interval, -0.1 to 1.3 mm] in RigidLoop Adjustable group and 0.53 ± 0.6 mm [95% confidence interval, -0.1 to 1.2 mm] in TightRope group). CONCLUSIONS: There were no significant differences between the two femoral cortical suspensory adjustable-loop devices regarding laxity outcomes or loop displacement as measured by button-to-graft distance migration. CLINICAL RELEVANCE: Use of either of the adjustable-loop cortical suspensory devices in our analysis would appear to produce similar, acceptable laxity outcomes and minimal effects in terms of device-related loop displacement.

Low frequency of symptomatic venous thromboembolism after multiligamentous knee reconstruction with thromboprophylaxis.

BACKGROUND: Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. QUESTIONS/PURPOSES: The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. METHODS: The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre- and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. RESULTS: Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. CONCLUSIONS: Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Distal Femoral Subchondral Metastasis Mistaken for an Insufficiency Fracture and Treated with Total Knee Arthroplasty: A Case Report.

CASE: A seventy-three-year-old woman who had been given the tentative diagnosis of spontaneous osteonecrosis presented to our clinic for a second opinion. Additional imaging and evaluation revealed the lesion to be a subchondral metastasis consistent with breast cancer. She received proper oncologic treatment and subsequent total knee arthroplasty. CONCLUSION: Orthopaedic surgeons should be aware of the possibility of metastatic disease manifesting itself in the form of an isolated subchondral lesion about the knee. For patients with such lesions, treatment in the form of total knee arthroplasty is a viable option that can provide excellent pain relief and function.

The diagnostic accuracy of inflammatory blood markers for purulent flexor tenosynovitis.

PURPOSE: For patients with purulent flexor tenosynovitis, our purpose was to (1) calculate the diagnostic accuracy of white blood count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for those who underwent surgical drainage, (2) to correlate these markers for those treated with antibiotics alone, and (3) to evaluate the accuracy of diagnosis for surgical patients. METHODS: A total of 82 consecutive patients (71 surgical and 11 nonsurgical) with flexor tenosynovitis were identified from orthopedic databases at 2 academic centers. We evaluated inflammatory markers (WBC, ESR, and CRP), radiographs, descriptions of surgical findings, and intraoperative cultures for all patients. For nonsurgical patients, we evaluated inflammatory markers for possible correlation with the presumed diagnosis of purulent flexor tenosynovitis. For surgical patients, sensitivity, specificity, positive predictive value, and negative predictive value were calculated individually for inflammatory markers. RESULTS: For nonsurgical patients, WBC, ESR, and CRP were elevated in 3 of 11 patients (27%), 6 of 8 patients (75%), and 6 of 7 patients (86%), respectively. For surgical patients, the intraoperative findings or cultures were consistent with infection in 69 of 71 cases (97%), whereas calcific tendinitis was diagnosed in 2 cases. Cultures were positive in 56 patients (79%). All 3 markers had a specificity and positive predictive value of 100%. For WBC, ESR, and CRP, respectively, the sensitivity was 39%, 41%, and 76% and the negative predictive value was 4%, 3%, and 13%. CONCLUSIONS: Commonly used inflammatory blood markers (WBC, ESR, and CRP) may be helpful in diagnosing purulent flexor tenosynovitis. If the levels of any of these markers are elevated in patients suspected of having the diagnosis, the likelihood of infection is extremely high. However, with low negative predictive values, these markers cannot reliably rule out infection. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Hyaluronic acids.

Hyaluronic acids (HAs) are the most versatile fillers on the market. Since their approval in Canada in 1998 and the United States in 2003, applications for facial contouring have been varied, with predictable and outstanding results. Numerous publications support their safety, durability, longevity, and application to reconstructive and cosmetic procedures for both surgical and nonsurgical applications. The incidence of complications is low, and the treatment of complications is relatively straightforward with the use of hyaluronidase. This article discusses the uses of the HAs in general, with regard to the various particles sizes (Restylane, Restylane Fine Lines, Perlane, Juvederm 18, 24, 30), which are available in Canada and will be available in the United States in the fall of 2006.