Paper #157 Treatment of chronic tendonosis with bipolar radiofrequency stimulation

The purpose of this study is to demonstrate the safety and document the effectiveness of bipolar radiofrequency for the treatment of chronic tendinosis. Prospective, non-randomized, single center pilot study. There were 24 patients in the study. Each had chronic tendinosis of the patellar tendon, Achilles tendon, or lateral or medial epicondyle. They all had symptoms for more than 6 months (average 16 months), and failed at least 3 conservative treatments. A pre-operative MRI and pain and function scores were recorded. The patients had open radiofrequency stimulation of the tendons involved using a bipolar Radiofrequency Topaz Wand TM (Arthrocare Corp., Sunnyvale, CA). The generator was set to power level of 4 (175V RMS). The wand was placed on the surface of the tendon and activated for 0.5 seconds at 5mm distance intervals around the symptomatic area. The tendon involved was stimulated 15–20 times over an area of 3.0 square cm. Post-operative pain and function scores were recorded at 7–10 days, 4 weeks, and 6 months. Post-operative MRI’s were performed at 4 weeks and 6 months. Ninety two percent of patients had significant improvement in their pain and function at 6 months. The post-operative VAS pain scores were decreased by 55% at 7–10 days post operative, 75% at 4 weeks, and 85% at the 6 month evaluation. There was significant improvement (p < 0.05) in the SF-36, IKDC, Upper Limb DASH, and the AOFAS scores. Seventy-five percent of the pre-operative MRI’s had changes consistent with tendinosis. Post surgical and tendinosis changes were observed in 96% of patients at 4 weeks. At 6 months, only 21% had tendinosis changes on their MRI. Bipolar radiofrequency stimulation appears to be a safe and effective treatment of chronic tendinosis. Further research is needed in this area to better understand the biochemical processes by which bipolar radiofrequency stimulation leads to pain relief and potential tendon repair.