March 13th, 2004
AOSSM Specialty Day

Treatment of Chronic Tendinosis with Bipolar Radiofrequency Stimulation

Authors:
  1. James P. Tasto MD, San Diego Sports Medicine and Arthroscopy Fellowship, San Diego, CA
  2. Jeffrey R. Cummings MD, San Diego Sports Medicine and Arthroscopy Fellowship, San Diego, CA
Objective:  The objective of this study was to evaluate the safety and effectiveness of bipolar radiofrequency (bRF) stimulation for the treatment of chronic tendinosis of the patella tendon, Achilles tendon, and common flexor and extensor tendon origins of the elbow (medial and lateral epicondyles).
Methods:  Twenty subjects with history and clinical findings consistent with chronic tendinosis received treatment. Subjects accepted to the study were between 18 and 65 years old, had tendinosis symptoms six months or longer, and had failed previous conservative treatment modalities. Bipolar RF stimulation was delivered to the symptomatic tendon using the Topaz Coblation device (ArthroCare Corp., Sunnyvale, CA). Patients were followed for at least 12 months after treatment. Pain was documented using a visual analog scale (VAS) self-reported measure and by tracking the amount of analgesic used over each follow-up interval. Functional outcome was assessed by obtaining IKDC subjective knee and the AOFAS hind foot evaluations in patellar subjects and Achilles subjects, respectively, and the upper limb DASH evaluation and grip strength measures in epicondyle subjects. Quality of life assessment was evaluated using the sf-36 questionnaire.
Results:   For all subjects, average age was 48.3±5.5 years, length of time spent with symptoms was 3.7±5.0 years, and number of failed previous treatments was 4.5±2.0 methods. After bRF stimulation, patients reported significantly reduced pain frombaseline (p<0.05). Pain reduction was statistically stable over the 12-month postoperative period (p<0.05). Functional outcomes and quality of life scores were improved over baseline values. No peri- or postoperative complications related to the device or procedure were noted.
Conclusions:  Bipolar RF stimulation appears to be a safe and effective instrument for the treatment of patients with chronic tendinosis. This mode of therapy may promote a healing response in diseased avascular tendons affected by chronic tendinosis.
Acknowledgements:  The authors thank Debby Holmes-Higgin, M.S., M.P.H. for technical contributions to the manuscript and assistance with statistical analyses, Renee Valeu, L.V.N. for project management, and Wendy Winters, B.S., Jean Wolozko, M.D., Ph.D., and Fred Harwood Ph.D. for invaluable contributions toward completing this study. Funding for this project was received from the Docere Foundation, San Diego, CA and the ArthroCare Corp., Sunnyvale, CA.
Keywords:
  1. Tendon
 Categories:
  1. CLINICAL: Elbow