A new technology for treating patients with tendon injuries is giving physicians a way to promote the healing of damaged tissue. Launched last year, the Tenex TX1 System uses a percutaneous tenotomy technique to specifically cut and remove damaged tendon tissue while leaving healthy tissue unaffected.
Robert E. Agee, MD, primary care sports medicine physician with Lemak Sports Medicine and Orthopedics, has used the system for several months and is excited about the possibilities it offers. “We use it most often on patients with chronic tendonitis who have shown no improvement with physical therapy and anti-inflammatories,” he says. “We are using the TX1 to heal, not just to repair.”
Agee says that before this technology was available, there was no answer for these chronic tendon problems. The innovative FAST™ technique – Focused Aspiration of Scar Tissue – uses the TX1 tissue removal system to treat lateral and medial epicondyle, patellar tendons, rotator cuff, plantar fascia, Achilles tendons, and quadriceps tendons. The system provides a safe and precise means of targeting the lesion and delivers the ability to cut and debride the unhealthy tissue to create an environment for new tissue to grow.
During the 15-minute out-patient procedure, approximately 20 to 30 needle passes are made through the abnormal region of the tendon with a 22-gauge needle using real-time sonographic imaging for continual guidance. If the tendon abnormality includes the bone-tendon interface, this area is targeted as well. If calcifications are identified on sonography, these areas are targeted with the same 22-gauge needle to disrupt the calcified growths.
“With the ultrasound, we can see what we are doing without having to surgically open the area,” Agee says. “Because the needle will not penetrate healthy tissue, the procedure is safe. The needle only goes through the soft, damaged parts of the tendon. The machine cuts out the bad tissue and aspirates it into a specimen bag.”
The use of the ultrasound offers advantages during the procedure. Sonography allows for confirmation of the diagnosis and ensures that all abnormal appearing tissue is treated, and conversely, that normal structures are avoided. Agee points out that it is important to have a skilled sonographer to assist in the procedure. “Sonographic guidance allows us to provide more accurate treatment than we could achieve if the procedure was attempted blindly,” he says.
The FAST technique is much easier on the patient, as well. It is less invasive and many physicians do the procedure in their clinics. Agee performs the procedure in the Gardendale Surgical Center in the event that a patient wants mild sedation. “We typically use only local anesthesia so the patient is completely awake during the procedure. The tiny micro-insertion needle minimizes risk and is closed with an adhesive bandage,” Agee says. “The entire procedure is quick and easy, and the patient’s pain level is much less than the more invasive procedures. In most cases, the patient completely recovers in four to six weeks.”
Agee says that the manufacturer currently is working on making needles that are larger than the current 2 ½ inch size. “A longer needle would allow us to perform deeper procedures,” he says. “Also, a longer needle would make it easier to treat larger patients. Tendons in their shoulders are hard to reach with the shorter needle.”
As a sports medicine physician, Agee has served as team physician for a number of sports in many parts of the country. He is recognized as one of the leading resources for primary care sports medicine and currently can be found on the sidelines of middle and high schools, collegiate-level games, and events throughout Alabama. He is the current head team physician for Alabama State University athletics and supports Miles University in its athletic care. As a result, many athletes have benefitted from Agee’s knowledge of the latest therapies for tendon injuries.
Agee says the technology being used for the FAST technique could possibly expand to other areas of medicine in the future. “We are at the point where medicine is beginning to catch up with technology. I believe we will do more with this technique as we become more skilled with ultrasound guidance,” he says. “With this technology we now are healing tendons, not just repairing them. I look forward to the application of this ability to other areas of medicine.”
