From the Guidelines
For a 76-year-old female with Achilles midsubstance tendinosis, I recommend the Tenex procedure over Topaz. Tenex (percutaneous tenotomy) is generally more appropriate for elderly patients as it is less invasive, requires only local anesthesia, has a shorter recovery time of 4-6 weeks, and causes less post-procedural pain. The procedure uses ultrasound guidance and a small incision to remove damaged tissue while preserving healthy tendon. In contrast, Topaz (radiofrequency microtenotomy) is more invasive, typically requires regional or general anesthesia, has a longer recovery period of 8-12 weeks, and may cause more post-procedural discomfort. Age is an important consideration here, as older patients generally benefit from less invasive approaches with shorter recovery times.
Key Considerations
- The patient's age and overall health status should be taken into account when deciding between Tenex and Topaz procedures 1.
- Conservative measures such as eccentric strengthening exercises, proper footwear with adequate support, and temporary activity modification should be continued post-procedure 1.
- The biological basis for Tenex's effectiveness is its precise removal of pathologic tissue and stimulation of a healing response without excessive trauma to surrounding healthy tissue.
Treatment Options
- Eccentric strengthening exercises have been shown to be effective in treating Achilles tendinosis 1.
- Proper footwear with adequate support and temporary activity modification can help reduce pain and promote healing 1.
- Topical and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) can provide acute pain relief, but their use should be limited due to potential side effects 1.
Diagnostic Considerations
- Plain radiography, ultrasonography, and magnetic resonance imaging (MRI) can be helpful in diagnosing Achilles tendinosis, but are not always necessary 1.
- A thorough physical examination, including inspection, range-of-motion testing, and palpation, can help diagnose Achilles tendinosis 1.
From the Research
Comparison of Topaz and Tenex for Achilles Midsubstance Tendinosis
- There are no direct comparisons between Topaz (percutaneous tenotomy) and Tenex (percutaneous tenotomy) for the treatment of Achilles midsubstance tendinosis in the provided studies 2, 3, 4, 5, 6.
- The provided studies discuss various treatment options for Achilles tendinosis, including nonsurgical management 3, conservative management 4, and the use of platelet-rich plasma (PRP) injections 5, 6.
- A study on a 77-year-old female patient with chronic Achilles tendinopathy reported successful treatment with a combination of conservative rehabilitation strategies, including medical acupuncture, Graston Technique, eccentric calf training, and rehabilitative exercise prescription 4.
- Another study found that PRP injections did not result in greater improvement in pain and activity compared to saline injections in patients with chronic Achilles tendinopathy 6.
- The studies suggest that nonsurgical treatment options, such as tendon loading exercises and symptom modulating treatments, may be effective for some patients with Achilles tendinosis 3.
- However, there is limited information available on the specific comparison between Topaz and Tenex for the treatment of Achilles midsubstance tendinosis in a 76-year-old female.