Joint Preservation Blog

January 10, 2009

Replacing the Achilles Tendon with a Cadaver Tendon?


As a doctor, replacing the Achilles tendon with a cadaver tendonwould be the absolute last resort for patients with complete and retracted tears of the Achilles tendon.  This means that the two pieces of the tendon aren’t connected.  For patients with partial tears of the Achilles tendon where the tendon is still intact and not completely torn and retracted, this should not be considered.  This is due to the significant complications that can accompany this type of very big surgery.  Newer methods of tissue bioengineering look to replace this Achilles tendon replacement surgery.  This involves injecting the patient’s own mesnechymal stem cells into the Achilles tendon tears.  We have some experience with injecting adult mesenchymal stem cells into torn tendons with very good results.  This procedure is much less invasive and involves much less recovery and downtime for the patient. 

January 2, 2009

achilles tendon repair

As a doctor, if I have a partial tear of my Achilles tendon, I’m not anyone near me with a knife! Why, surgery means big downtime and lots of trauma. Achilles tendon repair of a small tear shouldn’t require sutures, but instead the injection of the patients own adult stem cells into the tear. This state of the art technique repairs the tear with much less downtime. Click here to see how Achilles tendon repair is done in the 21st century.

Mesenchymal stem cells are present in everyone and have the ability to differentiate (turn into) tendon tissue and orchestrate a natural repair effort.

MRI Showing Tear Achilles tendon

MRI Showing Tear Achilles Tendon. MRI’s are pictures that show soft tissue as well as bones. The Achilles tendon is made of up dense collogen and often appears black on MRI sequences used to look for ligament or tendon tears (usually T1 or proton density sequences). A white or light colored area in the tendon on these sequences usually means a tear in the tendon. A partial tear is when the lighter colored area diesn’t extend all the way through the tendon and the two parts on either side of the tendon are still attached to one another. On the other end of the spectrum is a full or complete tear where the two ends are retracted and pulled apart. If the tear is partial, then the patient is usually immobilized in a walking cast or boot for several weeks. This aggressive immobilization can be a two edged sword, as the lack of activity can also weaken the area. If this doesn’t work, then surgery to sew the tear may be recommended, but this requires large amounts of downtime to allow the sutures to mend the area. Newer stem cell based treatments for partial Achilles tendon tears are injection based and allow for more activity.

December 15, 2008

achilles tendon tear bursitis

The Achilles tendon is the cord that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus).  This transmitts force to the foot for “toe off” in normal walking.  An Achilles tendon tear bursitis is when the tendon gets a partial tear (not through and through, but strecthed or torn a bit) and the bursa (lubricating sac between the tendon and the calcaneus bone) gets inflammed.  This bursitis can cause pain and is usualy from too much force on the tendon.  The cause of this problem is usually altered bio mechanics.  This means that things like excessive tightness in the claf muscle, too much weight on that side of the body, or even issues with range of motion of the hip or knee joints are overloading the achilles tendon.

The most traditional way to treat this is with a steroid injection into the busa.  While this can reduce the swelling in the bursa and some of the pain, it can also destroy the body’s ability to heal the tendon tear.  Steroids will reduce the activity of the body’s own stem cells it uses for repair.  Smarter ways to fix this problem would start with changing the biomechanics to reduce over load in this region.  Orthotics may help, as well as loosening the muscles in the calf and around the knee or hip joints.  Once that’s accomplished, newer non-surgical methods to treat this problem are now available.  These include prolotherapy injections into the tendon area.  These injections are used to cause a brief inflammatory healing reaction in the tendon.  While these may help, they can only rarely help strengthen the tendon in our experience.  The issue is that the Achilles tendon is such a big and dense tendon, getting the prolotherapy medicine into the tendon can be difficult.  In addition, accessing the exact area of the bursitis without x-ray guidance is almost impossible.  A newer alternative is the injection of the patient’s own stem cells into the bursa area under x-ray guiance.  This allows the stem cells to turn into new tendon material and strengthen the tendon and reduce the bursitis.  For information on this technique, see the link at the front of the first paragraph above.  This newer stem cell tecnique avoids surgery and allows for high activity levels after the procedure, unlike surgery which usually requires at least a walking boot for immobilization.

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