Microsurgical Tendon Debridement vs. Orthobiologics for Tendinopathy with Dr. Ashwin Rao. EP#568
Feb 24, 2025
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Dr. Ashwin Rao, a board-certified sports medicine expert and team physician for the University of Washington, shares insights on treating tendinopathy. He compares microsurgical tendon debridement and orthobiologics, highlighting the advantages of minimally invasive techniques. Dr. Rao discusses innovative outpatient procedures and the role of local anesthesia, enhancing patient experience. He also addresses the use of orthobiologics like platelet-rich plasma and stem cells, clarifying their benefits in pain relief and rehabilitation. Enthusiastic about community involvement, he encourages ongoing education in sports medicine.
Microsurgical tendon debridement is a minimally invasive procedure that rejuvenates chronic tendons by removing damaged tissue to promote healing.
Orthobiologics treatments like platelet-rich plasma aim to modulate inflammation and enhance healing in tendinopathies, albeit with realistic recovery expectations.
Deep dives
Overview of Microsurgical Tendon Debridement
Microsurgical tendon debridement is a minimally invasive procedure that targets pathologic tendon tissue through small incisions, distinguishing it from traditional surgeries that often require larger openings. The technique utilizes devices like 10X, which employs high-frequency oscillations to break down unhealthy tendon tissue using ultrasound guidance. This procedure is particularly useful in treating chronic tendon issues, as it aims to rejuvenate tendons that have progressed from tendonitis—an inflammatory condition—to tendinosis, a degenerative state requiring different treatment approaches. By removing damaged tissue, the treatment creates an environment conducive for the body to initiate a healing response and restore the healthy function of the tendon.
Understanding Orthobiologics and Their Applications
Orthobiologics represents a category of treatments that leverage the body's biological substances to enhance healing, particularly in tendinopathies and degenerative joint diseases. The most recognized type within this realm is platelet-rich plasma (PRP), which is used to modulate the local inflammatory environment rather than directly regenerate cartilage. By introducing growth factors from platelets into damaged areas, these treatments aim to stimulate healing processes and improve patient outcomes, especially in tendons that inherently possess better regenerative capacities compared to cartilage. It's crucial for patients to have realistic expectations, as while orthobiologics can alleviate symptoms, they do not necessarily restore original joint or tissue structure.
Patient Management and Expectations Post-Procedure
After undergoing microsurgical tendon debridement, patients should understand that recovery is a gradual process usually spanning three to six months, with significant improvement anticipated only after the first six weeks. Initial recovery focuses on managing expectations, where early stages involve minimal noticeable changes akin to a construction site with foundational work being laid. Rehabilitation protocols are critical for enhancing tendon strength and functionality, which include ranges from physical therapy to gradually reintroducing load-bearing activities. Patients will find that while they may experience quicker initial improvements compared to traditional surgeries, a full return to their desired activity levels will still require time and tailored rehabilitation.
Innovations in Tendinopathy Treatments
Developments in tendinopathy treatment have introduced various devices, including the TNJ device and Tendinova, each utilizing unique mechanisms to achieve tendon recovery. The TNJ relies on fluid jets for debridement, while Tendinova uses a vibrating needle that doesn't require an incision, making it less invasive. Both methods aim to eliminate unhealthy tendon tissue while minimizing damage to surrounding healthy structures, offering promising alternatives within the landscape of sports medicine. As new technologies evolve, they provide practitioners with diverse options that leverage less invasive strategies, ultimately aiming to enhance patient recovery and satisfaction in sports medicine practices.
On this episode of the AMSSM Sports Medcast (X: @TheAMSSM), host Dr. Jeremy Schroeder, MD, is joined by Dr. Ashwin Rao, MD, to provide a preview of his main stage presentation about Microsurgical Tendon Debridement vs. Orthobiologics for Tendinopathy during the 2025 AMSSM Annual Meeting.
Dr. Rao is board certified in family medicine and sports medicine, and is a Professor in UW School of Medicine's Department of Family Medicine. He is also a team physician for University of Washington Husky Athletics and a medical consultant for the Brooks Beast Middle Distance Track Club. He previously served as a team physician for the NFL’s Seattle Seahawks, Program Director of the UW Primary Care Sports Medicine Fellowship, and Co-Chair of the Education Committee on the Board of Directors of the American Medical Society for Sports Medicine (AMSSM).
In-person and virtual attendance options are still available for the conference. Register to attend the 2025 AMSSM Annual Meeting at annualmeeting.amssm.org.
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