Tendon Embolization

Background and indications

Chronic tendinopathies (shoulder, elbow, knee, ankle) are often associated with pathological tendon neovascularization, responsible for persistent pain and inflammation. Tendon neovessel embolization is an innovative technique that aims to occlude these abnormal vessels to reduce pain and promote healing.

Main indications include: refractory lateral epicondylitis (tennis elbow), chronic Achilles tendinopathy, patellar tendinopathy (jumper's knee), chronic plantar fasciitis, and rotator cuff tendinopathies resistant to conservative treatments (physiotherapy, injections, shockwave therapy).

Pre-procedure assessment

Assessment includes ultrasound or MRI confirming tendinopathy with neovascularization on Doppler, pain assessment (VAS, specific functional questionnaires), and documented failure of conservative treatments for at least 3 months.

Procedure

Under local anesthesia, a microcatheter is introduced through the femoral or radial artery depending on location. Under fluoroscopic guidance, arteries feeding the tendon neovascularization zone are catheterized in a super-selective manner. Small microspheres (75 µm) are injected to occlude pathological neovessels. The procedure takes approximately 45 to 75 minutes.

Results and scientific evidence

The concept was developed by Okuno and Sato in Japan. A series of 32 patients with refractory lateral epicondylitis showed significant pain improvement with mean VAS score decreasing from 69 to 12 mm at 4-year follow-up (Okuno et al., Journal of Vascular and Interventional Radiology, 2016; DOI: 10.1016/j.jvir.2016.02.036).

For Achilles tendinopathy, similar results have been reported with 70-80% pain reduction in responders. Overall clinical response rate is 70-85% at 12 months.

Risks and complications

Complications are rare and minor: puncture site pain (< 5%), transient skin discoloration (< 5%). Major complications (skin necrosis, nerve injury) are exceptional with small particle use and super-selective catheterization.

Recovery

Return to normal activities is possible the following day. Improvement is progressive over 2 to 8 weeks. An appropriate rehabilitation program is recommended in parallel. Follow-up is scheduled at 1, 3, and 6 months.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by a specialized interventional radiologist.