Radiofrequency Microtenotomy or Physical Therapy for Achilles Tendinopathy: Results of a Randomized Clinical Trial

Background: Achilles tendinopathy is a painful disorder, and various treatment options are available. Bipolar radiofrequency microtenotomy (RFM) has shown promising results in treating tendinosis. Purpose/Hypothesis: The purpose was to compare the results between treatment with bipolar RFM and physical therapy (PT) for patients with midportion Achilles tendinopathy. It was hypothesized that RFM would be equivalent or superior to PT. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 38 patients with midportion Achilles tendinopathy were evaluated for 2 years. The patients were randomized to receive either RFM or PT. There were 20 patients in the RFM group and 18 patients in the PT group. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the Foot and Ankle Outcome Score (FAOS). The degree of tendinosis was evaluated with magnetic resonance imaging (MRI) of the affected ankle performed before intervention and 2 years after intervention. Results: In both groups, the VAS scores at the 2-year follow-up were significantly improved compared with preintervention: from 7.2 ± 1.5 to 1.0 ± 1.4 for the RFM group and from 5.9 ± 1.3 to 3.1 ± 1.8 for the PT group ( P < .01 for both). Compared with the PT group, the RFM group had significantly better VAS scores at both the 1- and 2-year follow-ups ( P < .01 for both) and better scores on 4 of the 5 FAOS subscales at the 2-year follow-up ( P < .01 for all). MRI revealed an improvement in the tendinosis score in both groups, without any significant difference between the groups. Conclusion: In this randomized study, the clinical assessments revealed significant improvements in the VAS, FAOS, and tendinosis score as seen on MRI 2 years after intervention with either RFM or PT in patients with midportion Achilles tendinopathy. The improvement was significantly better in the RFM group with regard to VAS and FAOS, but not in the MRI appearance. Registration: NCT03274557 ( ClinicalTrials.gov identifier).

Use of a larger surface area tip on bipolar radiofrequency wands in hip arthroscopy is associated with significantly lower traction and total surgery times

ABSTRACT Clinical outcomes in arthroscopic hip preservation surgery have improved over the past two decades due to many factors, including advancements in technique and instrumentation. Complications following hip arthroscopy are associated with increased traction and overall surgical times. The purpose of this study was to compare traction and surgical times during hip arthroscopy using two different radiofrequency ablation wands produced by the same manufacturer. The authors hypothesized that the wand with a larger surface area would result in significantly less traction and surgical times. This study was a retrospective comparative investigation on patients who underwent arthroscopic surgery of the central, peripheral, peritrochanteric and/or deep gluteal space compartments of the hip. Both wands are 50-degree-angled probes, but the tip and shaft diameters are 3 and 3.75 mm for Wand A (Ambient Super MultiVac 50; tip surface area 7.1 mm2) compared to 4.7 and 4.7 mm for Wand B (Ambient HipVac 50; tip surface area 17.3 mm2), respectively. There was no difference (P = 0.16) in mean age of Wand A patients (30 females, 20 males; 35.2 years) versus Wand B patients (31 females, 19 males; 32.7 years). Traction time was significantly less in the Wand B group (41 ± 6 versus 51 ± 18 min; P &lt; 0.001), as was surgical time (102 ± 13 versus 118 ± 17 min; P &lt; 0.001). There were no significant differences in the number of labral anchors used or Current Procedural Terminology codes performed between groups. In conclusion, it was observed that the use of a larger surface area wand was associated with significantly less traction and surgical times during hip arthroscopy.

Endometrial ablation for women with heavy menstrual bleeding: A systematic review and network meta-analysis

Background: Endometrial ablation (EA) is a less invasive treatment alternative to hysterectomy for heavy menstrual bleeding, but which ablation technique works best remains unknown. Objectives: A systematic review and network meta-analysis to evaluate the efficacy of different first and second generation EA techniques. Search strategy: A systematic search of online databases from inception. Selection criteria: Randomised controlled trials of EA techniques. Data Collection and Analysis: Primary outcomes (amenorrhoea rate and patient satisfaction rate at short (up to 12 months), intermediate (between 12 months and 5 years), and long term (5 years or more) follow-up) and secondary outcomes (re-intervention rate) were compared between first and second generation EA techniques. Treatment effects of different second generation EA techniques were compared. Main results: Comparing first versus second generation EA, there was no significant difference in amenorrhoea rates at short (OR 1.27, 95%CI 0.83-1.95), intermediate (OR 0.79, 95%CI 0.48-1.30), or long term (OR 1.39, 95%CI 0.94-2.07) follow-up. This was the same with patient satisfaction rates at short (OR 0.76, 95%CI 0.53-1.09), intermediate (OR 0.76, 95%CI 0.47-1.23), and long term (OR 0.68, 95%CI 0.31-1.51) follow-up. No difference in re-intervention rates was demonstrated. Highest amenorrhoea rate was achieved with bipolar radiofrequency, followed by hydrothermablation, microwave and thermal balloon ablation. Conclusions: Second generation EA seem to be as effective as first generation techniques in achieving amenorrhoea, high patient satisfaction and low re-intervention rate. Bipolar radiofrequency ablation seems to be the best amongst second generation EA in achieving amenorrhoea. Funding: None Keywords: ‘endometrial ablation’, ‘menorrhagia’, ‘heavy menstrual bleeding’

Applications of Helium Plasma in Rejuvenation of the Face and Neck

Energy based devices have been developed for the purposes of tissue contraction and skin tightening. Its application in the face and neck have been explored using lasers, temperature controlled monopolar and bipolar radiofrequency, and ultrasound. The purpose of this chapter is to explore the various applications for the face and neck using Renuvion™, a unique energy driven device based on plasma generated from the combination of helium gas and radiofrequency energy. The advantage of this technology is its ability to offer precise delivery of heat to tissue with minimal thermal spread, in part due to the rapid cooling aided by the helium gas. We will explore the options in which this technology can be incorporated to rejuvenate the face and neck, the patient selection considerations in choosing method of approach, surgical technique, anticipated outcomes, potential concerns and or complications associated with this and expected perioperative care. Applications in the face and neck include: (1) Subdermally in the neck as a stand alone procedure with or without liposuction. (2) Subdermally in a limited incision, non-excisional technique with a concomitant platysmaplasty either with an open approach or percutaneous use of suture suspension for the platysmal muscle. (3) Subdermally in conjunction with an open traditional rhytidectomy involving skin excision. (4) Ablative resurfacing—fractional or pulsed and full continuous modalities (non-FDA cleared at the time of this writing). It is the authors’ experience that with appropriate patient selection this can be a powerful tool that can deliver skin tightening and rhytid reduction not seen by other technologies available.

An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure