Chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon injuries are often associated with significant physical dysfunction and disability, due to the limited self-repair capacity and propensity for scar formation. Non-insertional Achilles tendinopathy is a common cause of ankle pain and typically occurs 2 – 6 cm proximal to the tendon insertion on the calcaneus.
Athletes, whether elite or recreational, are the most common group to present with Achilles tendinopathy, but it is also found in people with advanced age, obesity, diabetes or hypertension. Other risk factors for Achilles tendinopathy include previous tendon injury, decreased muscle strength, altered gait kinematics, limited ankle dorsiflexion, training errors, and the use of steroids or fluoroquinolones.
Conservative Treatment for Achilles Tendon Tears
Conservative care of Achilles tendinopathy includes removal of precipitating factors, rest, training routine modifications and the use of orthotics to correct foot or ankle malalignment. Decreased myotendinous flexibility may be treated with stretching. Muscle weakness is treated with progressive eccentric strengthening exercises twice a day for up to 12 weeks using either the Alfredson or Silbernagel protocol. Combining these protocols with low-energy shock-wave therapy (ESWT) may improve outcomes. With this said, up to 33% of patients will fail conservative care and consider surgical excision of the pathologic tissue with or without tendon transfer augmentation.
Lipogems® for Achilles Tendon Tears
There is a new treatment option out there. Recent studies have demonstrated that lipoaspirate contains and produces growth-factors, such as platelet-derived growth-factor (PDGF), fibroblast growth-factor (FGF), transforming growth-factor beta (TGF-β), and vascular endothelial growth-factor (VEGF) 1. These growth factors are known to play an important regulatory role in cellular proliferation, cellular migration, matrix synthesis and angiogenesis. The Lipogems® system can produce a non-expanded, rinsed, and microfragmented adipose tissue graft that maintains an intact stromal vascular niche and contains cellular elements with mesenchymal stem cell and pericyte characteristics
Recent Case Study
Dr. Christopher Rogers recently presented a case study at the TOBY conference in Las Vegas. He and his team were able to successfully treat a 16 year old girl who had developed functionally limiting chronic Achilles tendinopathy and partial tear that were non-responsive to conservative care. She was treated with ultrasound guided lipoaspirate (Lipogems®) and LP-PRP injection combined with a progressive strengthening program. She achieved a resolution of her pain and restoration of physical function at the six month follow-up. Ultrasound and MRI imaging revealed a diffuse fibrillar pattern consistent with regenerated tendon fibers that had replaced the tendinopathic and partially torn tendon regions.
Tendon engineering is an interesting challenge for the orthopedic medicine physician. Lipoaspirate and LP-PRP have the potential to stimulate tenocyte proliferation, matrix synthesis and angiogenesis which can lead to regeneration of a degenerated Achilles tendon. Future clinical trials using lipoaspirate for the treatment of chronic Achilles tendinopathy and partial tears are warranted.
We’re pleased to have been the first medical center in San Diego to offer the revolutionary LIPOGEMS® regenerative medicine therapy. Call us today to schedule an appointment. 760-909-2355
Participating in sports has a number of benefits for young athletes, but it also has its hazards. The Centers for Disease Control and Prevention (CDC) has reported that over 2.6 million children 19 and under end up being treated in hospital emergency rooms for sports injuries. A sports injury can affect males and females of all ages and athletic levels. It can keep you on the sidelines for weeks or months on end, and that’s simply not acceptable for most athletes. Here are a few problems young athletes need to be aware of.
Sprains and Strains
Sprains and strains are a very common type of sports injury. A sprain is an injury to a ligament—a band of tissue that connects bones to a joint—while a strain involves muscles and/or tendons. A strain involving a muscle is sometimes called a “pulled muscle.” Sprains and strains are common injuries in almost any sport.
Elbow Injuries
Tennis elbow and golfer’s elbow are extremely common overuse sports injuries. They cause pain around the elbow joint and are generally seen in athletes who participate in sports that require repetitive wrist extension and twisting, such as tennis, golf and baseball. Symptoms of elbow injuries are pain, stiffness, tingling or numbness, and pain when gripping or lifting.
Shoulder Injuries
If your sport requires repetitive overhead movements—such as swimming, tennis and baseball—your shoulder is at risk There are many different treatment methods available for shoulder pain, most of which offer helpful yet short-term solutions. If you are looking for a long-term solution that will help heal your shoulder, our regenerative medicine therapies may be the right choice for you.
ACL Injuries
An ACL injury is a type of sprain, affecting the anterior cruciate ligament (ACL), the most commonly injured ligament in the knee. A torn ACL of any grade is caused by sudden twisting of the knee. Sudden changes in direction while running or falling on one’s knee can also cause a torn ACL. The ACL injury has three grades:
Grade I is the least severe. The ligament is stretched but not torn, and there is only a little tenderness and swelling. The knee does not feel unstable or give out when being used.
In Grade II, the ligament is partially torn, and there is moderate swelling and tenderness. The knee may give out when being used.
A Grade III injury is the most severe. The ligament is completely torn or ruptured, but there is surprisingly little pain. The amount of swelling can vary from a little to a lot. The ligament cannot control the knee, so it will feel unstable and give out.
Girls are more susceptible to torn ACLs than boys. Basketball players, soccer players and football players are particularly vulnerable.
Repetitive Motion Injuries
A young athlete can also be prone to repetitive motion injuries like stress fractures or tendinitis (inflammation of a tendon). This type of sports injury is caused by overuse of the affected muscle, bone and/or tendon. About 50 percent of all sports injuries treated by doctors are repetitive motion injuries. Tendinitis and bursitis (inflammation of a bursa) are the most common types. Repetitive motion injuries are most common in the knees, elbows, shoulders and heels.
We are dedicated to providing excellent pain relief and complete, natural healing. We do not simply focus on your symptoms, because only comprehensive care will produce long-lasting results. Our team of physicians, therapists and educators will work with you to develop a customized treatment plan that results in quicker recovery and enhanced physical performance. Once you have recovered from your spine or joint injury, we will provide education, exercise training and nutritional support to help you become stronger and healthier than ever before. Call us today to schedule an appointment. 760-483-9060
