Dr. Yuji Okono Publishes Article on Transcatheter Arterial Embolization for Refractory Tendinopathy and Enthesopathy
Dr. Yuji Okuno recently published a new article in the Journal of Vascular and Interventional Radiology titled “Transcatheter arterial embolization using imipenem/cilastatin sodium (CS) for tendinopathy and enthesopathy refractory to nonsurgical management.” This case series followed seven patients in which conservative management failed for tendinopathy/ enthespathy-related pain at several locations including patella, rotator cuff, plantar fascia, lateral epicondyle, iliotibial band and Achilles. All patients had a persistent Visual Analog Scale score of >50 after 3 months of conservative therapies including rest, anti-inflammatory drugs, ice, stretching, strengthening, corticosteroid injections, physical therapy, and iontophoresis.
For each patient included in the study, percutaneous arterial access was gained and an angiographic catheter was advanced towards the area of tendinopathy/ enthesopathy. Digital subtraction angiography was performed to locate abnormal neovessels at sites of tendinopathy and enthesopathy, after which a micro-catheter was selectively placed in the targeted arteries. Then, a suspension of imipenem/CS was injected in 0.5-mL increments until blood flow stagnated under live angiography.
Technical success (i.e. devascularization of target vascular bed) was obtained in 100% of subjects. No major adverse events occurred related to the procedures. Pain was assessed by using the VAS at study entry, 1 day, 1 week, and 1 and 4 months after the procedure. Results revealed significantly decreased mean VAS scores at all follow up appointments. On average, the mean VAS was 73mm before treatment. At 1 day post-procedure, the VAS reduced to 17mm. Tracking results further, at 1 week the mean was 16mm, 1 month was 14, and at 4 months was 10mm.
Across the seven subjects studied, transcatheter arterial embolization with imipenem/CS for tendinopathy and enthesopathy was safe and associated with significant reductions in VAS scores that lasted for 4 months. The results speak to the variety of different theories proposed regarding the pathophysiology of painful tendinopathy and enthesopathy. This study by Dr. Okuno and his colleagues supports the hypothesis that a dysvascular and/ or hypervascular etiology may underlie the painful symptoms associated with tendinopaties and enthesopathies, and that the neovessels seen in these conditions might not contribute to healing. Increased research efforts and larger studies are needed to further investigate the variety of proposed mechanisms, which could potentially lead to increased treatment options in the future.
See Dr. Okuno live and more of the latest research on regenerative medicine and hands-on musculoskeletal ultrasound cadaver lab at the 6th Annual TOBI: The Orthobiologic Institute PRP & Regenerative Medicine Symposium with Cadaver Lab June 12-14, 2015in Las Vegas, www.prpseminar.com. Save $300 OFF Registration with Promo Code: TOBIBLOG
PubMed ID: 23707086