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AJR September 2016

               Christopher Burke
               Hospital for Joint Diseases
               New York University
               Langone Medical Center
               New York, NY

Ultrasound-Guided Percutaneous Tendon Treatments

The use of ultrasound to direct treatments for tendon disease improves accuracy and performance by facilitating visualization of the target and relevant adjacent structures.

1. Are there any negatives associated with ultrasound-guided percutaneous tendon treatments?

There have been no significant untoward effects of percutaneous ultrasound-guided treatments reported to date; in fact, real-time monitoring allows higher levels of precision, which enhances its safety profile. A potential limitation is poor target anatomy visualization, for example, due to extensive subcutaneous fat distorting the insonating ultrasound beam or suboptimal acoustic access, which can result in poor needle identification.

2. Are there any preferred therapies associated with sonographic guidance?

Sonographic guidance is particularly amenable to precise targeting of the affected tendon regions, for example, with tenotomy and biologic treatments. And while this approach may be changing, most intratendinous therapies have previously been reserved for situations in which other conservative approaches have failed.

3. Is this a cost-effective method of treating tendon disease?

The cost has varied significantly among institutions. This, in part, may relate to the lack of insurance coverage for many of these procedures. Having said that, the goal of intratendinous therapy is to obviate the need for surgery while producing a true healing response. This means fewer associated co-morbidities, faster return to work, and improved quality of life, thereby ultimately being highly cost-effective.

4. Is there anything about the study that surprised you?

The broad spectrum of intratendinous therapies that have been employed to date and the potential new treatments. As stem cell therapies become increasingly available, their use may ultimately replace other conventional percutaneous tendon treatments.



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