Is Microdebridement A Viable Option For Treating Tendinosis?

By Anthony Leone, Special Project Editor

Many people suffer from tendinosis or similar tendon aliments that involve tissue scarring. In seeking relief for their pain and discomfort, patients may try a variety of conservative modalities ranging from bracing to injections. If conservative methods fail, there is another option before one considers the possibility of an invasive surgical procedure. The Topaz Microdebrider (Arthrocare) enables clinicians to perform microdebridement of soft tissue, such as tendons, in the foot and ankle. Essentially, the device uses radiofrequency energy to cause microscopic “trauma” to the scar tissue. This increases blood flow to the affected area and facilitates healing, according to Babak Baravarian, DPM, the Co-Director of the Foot and Ankle Institute in Beverly Hills, Ca. While Dr. Baravarian notes that traditional surgery also causes trauma to tissue, he says the Topaz Microdebrider allows surgeons to have more precise control in treating the affected tendon while preserving the anatomical structure of the tissue. How Does The Device Work? Facilitating that precision is the Topaz Microdebrider’s use of Coblation technology. Arthrocare notes that most radiofrequency-based surgical devices such as lasers employ heat-driven processes whereas Coblation technology operates at lower temperatures. The company says Coblation enables one to gently dissolve target tissue and minimize damage to surrounding healthy tissue. The procedure itself usually takes less than 20 minutes to perform, according to Arthrocare. After making a small incision about an inch long, the surgeon would apply the Topaz Microdebrider on and around the affected tendon for half-second duration treatments 1/4 inch apart until forming a grid-like pattern. The company says on every fourth application, the surgeon inserts the device deep into the tendon, approximately 1/4 inch in depth. While directing a light dose of radiofrequency energy into the tissue, one can remove small amounts of tissue, according to Arthrocare. Assessing The Benefits Of The Device Dr. Baravarian, the Chief of Podiatric Surgery at the Santa Monica/UCLA Medical Center, says the Topaz device is easier to use in the majority of cases than more conventional surgical procedures for tendinosis. He also cites quicker recovery times for patients. “There is a faster recovery time with the Topaz device whereas there is a longer recovery period with traditional surgery and the results are not as good,” explains Dr. Baravarian, who has used the Topaz Microdebrider for the past year. Joe Southerland, DPM, also praises the Topaz Microdebrider. In addition to removing scar tissue and tendons, Dr. Southerland has used the Topaz Microdebrider to help treat cases of chronic fasciitis. “My results have been very good with (the Topaz Microdebrider),” offers Dr. Southerland, who is in private practice at the Arlington Foot Center in Arlington, Texas. “For me, it does not change the mechanics (of treating the ligaments or tendons).” Dr. Baravarian emphasizes proper patient selection. He says clinicians should reserve this device for those who have not experienced pain relief after trying conservative modalities such as bracing or injections. While he says the Topaz Microdebrider works well in healing scar tissue, Dr. Baravarian would not recommend the device for treating tendon tears. Since the Topaz Microdebrider is a relatively new technology, there may be some cost issues, according to Dr. Southerland. However, Dr. Baravarian has found that most insurance companies accept the Topaz Microdebrider procedure.

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