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 Support Socks

The Achilles tendon can be weakened by injury or being overloaded.  Support socks for the Achilles tendon will add compression around the tendon which may allow it to feel like it has greater support.   In essence, this pressure gives the tendon more structure.  Look for support socks that place pressure on the tendon (the heel cord) without causing pain.  The need for support in the Achilles tendon is usually from a partialtear or chronically frayed tissue in the tendon.  Another way to treat this without surgery or bracing is to use the patients own stem cells to repair the tendon.  These are cells taken from the patient, grown in the lab, and then injected into the tendon so that they can orchestrate a healing response.  With this type of Achilles tendon repair therapy, the need for Achilles tendon support socks can be eliminated.  This type of Achilles tendon treatment is new to the US and holds great promise for making the tendon stronger.

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.

December 14, 2008

Torn Achilles Tendon Physical Therapy

A tear in the Achilles tendon can be either partial or complete.  Torn Achilles tendon physical therapy depends greatly on how the tendon is treated.  Surgical repair usually means significant immobilization.  This is a two edged sword.  On the one hand, immobilization can help the tendon mend, on the other, it also dramatically weakens the strength of the natural repair.  For a complete tear of the tendon (when it’s disconnected), aggressive casting may be the only way to promote even weak repair.  However, when the ligament is partially torn, the rehabilitation and recovery plan can vary widely depending on treatment method.

The rehab plan depends on if surgery is needed or not.  If the tendon is sewn back together, rehab will have to be non-weight bearing (on crutches) so at least 4-8 weeks.  However, there is a better way that can allow for quicker return to activities.  Recent research has shown good results when implanting the patient’s own adult stem cells into the tear.  This treatment technique is available now to patients in the first link above.  This is an injection of stem cells to heal the partial tendon tear.  If the Achilles tendon is repaired by this method, activity can start immediately as it helps stem cells differentiate into fibroblasts to repair the tendon.

For our patients, it’s critical to get rid of myofascial trigger points in the gastrocnemius muscle.  This can be accomplished by IMS.  This allows the muscle to function normally and allows for quicker strengthening of this critical muscle.

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