Abstract
BackgroundTendinopathy is a common clinical pathology, with mixed treatment results, especially when chronic. In this study, we examine the effects of an ultrasonic debridement modality in a rabbit tendinopathy model.We asked four questions: 1) Was it possible to create and visualize with ultrasound a tendinopathy lesion in a rabbit Achilles tendon? 2) Was it possible to guide a 19-gauge ultrasonic probe into the tendinopathy lesion? 3) Following ultrasonic treatment, was tendinopathy debris histologically present? and 4) Was the collagen profile qualitatively and quantitatively normalized following treatment?MethodsSkeletally mature female New Zealand white rabbits (n = 12) were injected with, ultrasonography localization, 0.150 ml of collagenase into the Achilles tendon. The collagenase-induced Achilles tendinopathy (3 weeks) was treated with percutaneous ultrasonic debridement. The tendons were harvested, at 3 weeks after treatment, and were subjected to histological assessment (modified Movin score) and biochemical analysis (collagen isoform content).ResultsHistopathological examination revealed that all tendons injected with collagenase showed areas of hypercellularity and focal areas of tendon disorganization and degeneration. The treated tendons had lower (improved) histopathological scores than injured tendons (P < 0.001). Western blot analysis showed that ultrasonic therapy restored, within statistical limits, collagen type I, III, and X expressions in a treated tendon, to qualitative and semi-quantitative levels of a normal tendon.ConclusionsWe were successfully able to create a collagenase-injected tendinopathy lesion in a rabbit Achilles tendon and visualize the lesion with an ultrasound probe. A 19-gauge ultrasonic probe was inserted into the tendinopathic lesion under direct ultrasound guidance, and minimal tendinopathic debris remained after treatment. The treated tendon demonstrated a normalized qualitative and semi-quantitative collagen profile and improved histological appearance in the short term. This technique demonstrates scientific merit with respect to the minimally invasive treatment of tendinopathy and warrants further studies.Clinical relevanceRecalcitrant tendinopathy has evaded consistent non-operative treatment since the tendinopathic debris remains in situ, to some extent, with non-operative approaches. This percutaneous emulsification/evacuation approach, under direct ultrasound visualization, has the potential to cure recalcitrant tendinopathies without open surgery, which would benefit the patient and result in significant healthcare cost reductions.
Highlights
Tendinopathy is a widespread cause of morbidity affecting virtually all joints
Clinical relevance: Recalcitrant tendinopathy has evaded consistent non-operative treatment since the tendinopathic debris remains in situ, to some extent, with non-operative approaches
Our pilot study aims were to create a collagen degradation/tendinopathy rabbit model from literature data, treat the lesion using an ultrasonic aspiration probe, and analyze the results with histology and semi-quantification of the collagen profile
Summary
Tendinopathy is a widespread cause of morbidity affecting virtually all joints. the etiology is imperfectly understood, the path physiology is one of the degeneration and necrosis at the pathological site [1]. Magnetic resonance imaging (MRI) and ultrasound scanning are commonly utilized to provide fine internal architectural details of symptomatic tendons, for diagnosis and evaluation of treatment [5]. In order to understand tendon biology and mechanics in normal and injury situations, a mouse model is commonly used [6, 7]. Our choice of treatment is based on the previously published clinical use of ultrasonic energy to treat lateral epicondylitis [10]. We examine the effects of an ultrasonic debridement modality in a rabbit tendinopathy model. We asked four questions: 1) Was it possible to create and visualize with ultrasound a tendinopathy lesion in a rabbit Achilles tendon? We asked four questions: 1) Was it possible to create and visualize with ultrasound a tendinopathy lesion in a rabbit Achilles tendon? 2) Was it possible to guide a 19-gauge ultrasonic probe into the tendinopathy lesion? 3) Following ultrasonic treatment, was tendinopathy debris histologically present? and 4) Was the collagen profile qualitatively and quantitatively normalized following treatment?
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