Alex Garcia, MD Affinity Orthopedics and Sports Medicine
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1 Alex Garcia, MD Affinity Orthopedics and Sports Medicine
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3 Intact Tendon Reactive Inflammatory Tendinopathy Degenerative Chronic Tendinopathy INSULT Neurovascular Mediation Reparative Process? Healed 3
4 % Resolution ? Months Binder et al, Br J Rheum, 1983 Sanders et al (Mayo), Am. Journal Sports Med,
5 Protect: Brace -Reduce Load Rest-Compliance ICE NSAID Physical Therapy: iontophoresis strengthening exercises
6 Cortisone injection (+/- fenestration) - Provide pain relief short term, but effectiveness long term questioned - Used for diagnostic and therapeutic purposes Physical Therapy: ART, ASTYM/Graston, dry needling Platelet Rich Plasma: safe, effectiveness?, not covered by insurance
7 Percutaneous tenotomy using Tenex tool: minimally invasive Surgical Debridement: fully invasive
8 TX1 Console TX1 MicroTip Percutaneous (18 gauge) pen-like function Pre-assembled w/foot pedal activation Single use entirely disposable 8
9 Console delivers optimized ultrasonic energy to tip of TX1 instrument that precisely cuts diseased tendon tissue while sparing healthy tissue harmonic resonance of diseased tissue (necrotic) is different from healthy tissue (elastic) Cutting of targeted tissue is achieved through longitudinal movement of needle at speed of sound (ultrasonic) tissue is cut via jack-hammer effect Continuous saline irrigation cools TX1 Microtip to control unwanted heat and coupled to simultaneous removal of target tissue 9
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11 Patellar Tendonosis Patella Healthy Tendon Orange strip marks placement of ultrasound transducer on inferior pole of patella Patella Hypoechoic/Damaged Tendon 28
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19 Achilles Tendonosis Calcaneus Healthy Tendon Orange strip (a) marks placement of ultrasound transducer on Achilles and (b) shows cross section view to identify mid-substance tendonosis Calcaneus Hypoechoic/Damaged Tendon 34
20 Plantar Fasciitis/Fasciosis 37
21 Chronic Tendonosis Treatments Tenex Health has treated over 25,000 pts since Feb 2012 Elbow tennis + golfers elbow 33% 2% Shoulder Over-use workers/athletes % of 25,000 treated Skin Tendon 8% Knee basketball, volleyball Plantar Fascia 25% foot visits Scar Tissue Bone 38% 19% Achilles 10% of runners CONFIDENTIAL 10
22 Patient Selection Chronic pain (> 3 months) at the affected joint and not responsive to conservative medical treatment (rest, ice, brace, physical therapy) Point tenderness point of maximum pain typically corresponds to the location of the damaged tissue Ultrasound confirmation placement of ultrasound transducer on the site of maximum tenderness should identify a region of degenerated tendon tissue visualized as a hypoechoic region due to irregular/disorganized fibers and thickened tendon tissue. 14
23 No restrictions before procedure Cost-Effective and Well-Tolerated Total procedure time from cleaning of skin to placing band-aid is less than 20 min. No pain or discomfort during procedure Permitted to go home afterwards Post-procedure Over-the-counter pain meds and ice as needed, rare to prescribe for pain control Refrain from heavy lifting or in boot for 2-4 weeks Return to full activity in 4-6 weeks Resolution of Symptoms 80% better in 1-3 months, can take up to 6 months 15
24 Complications of the 25,000 cases 1 tendon rupture (fluoroquinolone & > 70 percent tendon degenerated) 2 temporary nerve injury due to lidocaine injection self resolved 2 infections both responded to topical antibiotics 1 skin blister self resolved 23
25 In Print/Accepted Koh American Journal Of Sports Medicine (Elbow) Hackel Orthopaedics Today (Procedure Overview / Mixed Tendons) Morrey Techniques In Elbow And Hand Surgery (Elbow) Elattrache Operative Techniques In Sports Medicine (Knee) Barnes Operative Techniques In Sports Medicine (Procedure Overview) Khanna Am Academy Of Physical Med & Rehab Poster (Mixed Tendons) Traistor Am Medical Society Of Sports Medicine (Mixed Tendons) Barnes Journal Of Shoulder And Elbow Surgery (Elbow) Patel Journal Of Orthopedics (Plantar Fascia) Sanders American Journal Of Sports Medicine (Epidemiology Study) Stuhlman Journal of Sports Medicine (Patellar Tendon) Kamineni Journal of Orthopedic Research (Basic Science) Submitted/In Preparation Koh Two and Three Year Clinical Follow-up / American Journal Of Sports Medicine (Elbow) Patel Plantar Fibroma Study Razdan Plantar Fascia Study Freed Achilles Tendon Study Yanish Economic Study Of Tenex Vs Open Surgery Study revealed 90% 0f patients pain free within weeks of treatment Cost Effective Intervention Less expensive ($11,000) and quicker recovery time vs surgery Sustained Pain Relief With Long Term Follow-up (6 36 Months) Strong Safety Profile 25
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