Dr. Nicholas Anastasio, Mercy Medical Center non-surgical orthopedics doctor, talks about healing the Achilles heel with tenotomy.
Interview conducted by Ivanhoe Broadcast News in 2023.
We’ll do a tenotomy first because we interviewed Barbara and remember her distinctly. What exactly did you do for her?
ANASTASIO: We performed a percutaneous tenotomy procedure which is a big mouthful for a small surgery that we do under ultrasound for chronic tendon problems. What we do is we use a needle under ultrasound just like a scalpel to perform a small surgery on the tendon without the need for open surgery or general anesthesia. We can do it here in the office fairly quickly. It’s used to treat chronic scar tissue in tendons.
Are you breaking up the scar tissue by doing that?
ANASTASIO: What we’re doing essentially is re-establishing the blood flow to the tendon. The reason why these tendons don’t heal or why patients are told they have chronic bursitis or chronic tendonitis is that over time, scar tissue forms in the tendon and it blocks the blood flow from penetrating the tendon. That’s why the tendon can’t heal. The procedure re-establishes that blood flow and it does mechanically break up the scar tissue to a degree, and then allows the body to take over and heal and remodel the tendon.
This is much less invasive than previous methods of getting rid of the scar tissue. How does it compare to what used to be done?
ANASTASIO: Traditional open surgery, the efficacy or outcomes weren’t great because open surgery creates scar tissue. You’re taking one step forward and two steps back. With this procedure, we’re able to do the same exact surgery but without open surgery. Then for the patient, it’s much more safe and convenient because we’re not using general anesthesia and exposing to those risks. We can do it here in the office without needing to schedule an actual OR room to do the procedure.
You said over time your scar tissue collects because she did mention that, that it was a repetitive injury.
ANASTASIO: Oftentimes from repetitive injury or bouts of inflammation, patients are told they have a bursitis or tendonitis, and that may be the case early on. But over time, as the tendon gets inflamed and heals and inflamed and heals, some scar tissue starts to accumulate, and that snowballs over time. What you get is this thickened scared up tendon that’s no longer inflamed. The traditional treatments of steroids shots and anti-inflammatories don’t work anymore because the problem is no longer inflammatory.
What would work if there were associated pain?
ANASTASIO: What we do for these procedures is the tenotomy procedure. That allows the body to heal properly by re-establishing the blood flow to the tendon and kicking off the healing cascade that the body uses to heal tendons. Your body has the ability to heal soft tissues. It just needs adequate blood flow to the area in order to achieve that.
In Barb’s case, a lady who is an Iron Man competitor, she couldn’t walk up the stairs. When she first came into you, what were your thoughts?
ANASTASIO: She came in with a fairly classic case, Achilles Tendinosis. She had been told for years that she had Achilles Tendonitis problems. She had lost her ability to do her hobbies that she loved to do like running and cycling and competing and she had a fairly classic exam and story for chronic tendinosis. We talked to her about our options including the ultrasound-guided tenotomy procedure, and she did great with it. Within a few weeks, her pain had been improving. The good news is, once you respond well to that tenotomy, the effects are long-lasting. We see general relief long-term from the procedure and that’s been demonstrated in the literature as well. Following patients that have success with this procedure, the effects last.
In the case of someone who’s had it for a long time, what would you advise them about seeking out all of the options? Maybe she could have been fixed sooner.
ANASTASIO: The trouble is, it’s a newer procedure. It’s been around for about seven or eight years, but you have to have ultrasound skill to be able to do it. A lot of physicians are simply not aware that it’s an option. We are trying to promote the word out there that this is available. If patients have chronic tendon pain or chronic bursitis that just keeps coming back, then we hope they’d consider coming to see us.
When they come back for the follow-up and subsequent visits, are you seeing a totally different person with that set of injuries?
ANASTASIO: You do have to think of this as recovering from a surgery. It takes time for the body to go in at the cellular level and repair the tendon. It takes on average about three months to reach zero to mild pain. We follow the patient about halfway through the process and at the end and what we see is a steady improvement over that time.
With Barbara’s case, she’s almost back to action. Is that a good feeling as a physician?
ANASTASIO: It’s one of the most satisfying procedures that I do because I get to see patients who’ve had pain or issues for years and they feel like they have no options and I can give them a good option that will get them relief.
Can you do a comparison on how this fixes as opposed to any other method or just living with the pain on steroids?
ANASTASIO: The traditional methods aren’t effective, and patients see that firsthand because that’s what they’re offered oftentimes; anti-inflammatory medications, physical therapy, cortisone injections. The traditional surgeries are still out there, but as we discussed, the efficacy and outcomes of those procedures are not as great because of the effects of surgery itself creating some scar tissue. There’s some other regenerative medicine techniques out there like PRP or some people may hear of, “stem cell injections”, but those are not covered by insurance and they’re quite expensive. The good news about this procedure is that it is generally covered by insurance without any problems.
It seems like medicine is taking a turn into discovery after discovery. Are you seeing that in your field?
ANASTASIO: I think that’s part of the reason why I went into medicine. It’s a field that’s constantly evolving. You have to be a lifelong learner or someone who’s interested in continuing to reevaluate and reassess the options and be willing to scrutinize the established methods for treating things. Yes, of course, we’re seeing changes every year in medicine. I don’t think that’ll ever change.
And Barbra’s outcome prognosis?
ANASTASIO: It’s fantastic. She’s doing great and we expect her to get a full recovery and back to her activities without any issues.
Do even people who are in the older-skewing range, heal quickly?
ANASTASIO: I’ve done this procedure on a variety of age ranges and actually, most patients are a little bit older because it takes some time to develop the scar tissue. You don’t really see it as much in teenagers. I’ve treated patients all the way into their 70s and 90s and I had success.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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