Percutaneous ultrasonic debridement of tendinopathy-a pilot Achilles rabbit model

Srinath Kamineni, Timothy Butterfield, Anthony Sinai, Srinath Kamineni, Timothy Butterfield, Anthony Sinai

Abstract

Background: Tendinopathy 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?

Methods: Skeletally 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).

Results: Histopathological 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.

Conclusions: We 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 relevance: Recalcitrant 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.

Figures

Fig. 1
Fig. 1
a (A) A normal betadine prepared rabbit Achilles tendon site. (B) An Achilles tendon at 3 weeks after collagenase injection demonstrating a fusiform swelling at the injection site. b (A) A normal Achilles tendon with a diameter A-A, (B) A collagenase-injected Achilles tendon after 3 weeks (group 1) with a significantly enlarged diameter B-B
Fig. 2
Fig. 2
a Ultrasound scan of a rabbit Achilles tendon demonstrating a fusiform tendinopathic swelling and the internal tendon architecture 3 weeks after collagenase injection. b Ultrasound of the Achilles tendon demonstrating diffusion of the injection throughout the tendon
Fig. 3
Fig. 3
Staining of Achilles tendon sections with hematoxylin-eosin. a Normal Achilles tendon, b necrosis and disorganization induced by collagenase at 6 weeks, and c the histological appearance after 3 weeks of collagenase and 3 weeks of treatment reveals a repopulation of the evacuated cavity and early collagen bundles
Fig. 4
Fig. 4
a Semi-quantification of collagen subtypes using western blot analysis. b The Y-axis corresponds to signal intensities: (A) collagen I (129 kDa), (B) collagen III (138 kDa), and (C) collagen X (66 kDa)

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Source: PubMed

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