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Melbourne Radiology Clinic

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Oct 20th

Autologous Tenocyte Implantation / Therapy

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Autologous Tenocyte Implantation (ATI) / Therapy (ATT) is a type of procedure which is performed at Melbourne Radiology Clinic to treat tendinopathy/tendinosis. This is a regenerative procedure whereby a patient's own healthy cells are harvested, grown in a laboratory and then re-injected into a diseased painful tendon. The newly injected cells produce collagen and healthy tendon tissue, strengthening the injected tendon, improving its function and also minimising pain. ATI is available to everyone, from the professional Olympic athlete to patients with recalcitrant tendon pain.. An ultrasound scan will be used to guide the procedure


Introduction

Tendons connect muscle to bone, transmitting the forces generated by muscle contraction onto bones and thus are crucial for the mobility of all joints. Like any tissue, tendons may be damaged due to trauma and also undergo age related "wear and tear" (degeneration). With increasing age, the number of tendon cells (tenocytes) decline, resulting in the tendon having limited ability to repair itself. Ultimately, the tendon loses its integrity and develops tears, being unable to withstand normal day to day activities. This most commonly manifests as joint related pain and loss of function. Overall, this process of tendon degeneration is known as tendinopathy or tendinosis, commonly (though incorrectly) referred to as "tendinitis". Unfortunately, the body's reaction is unable to reverse this process. ATI is however able to artificially restore the tenocyte population, with the aim of improving tendon structure, strength and function, thereby minimising tendon related pain. Naturally, any tendon of the body can be injected, with the most commonly injected areas being the elbow (common extensor tendon), knee (patellar tendon), ankle (Achilles tendon), hip/buttock (gluteal and hamstring tendons) as well as the shoulder (supraspinatus tendon).

Preparation

  • No specific preparation is required on the day of treatment.
  • We recommend that you bring a responsible person to drive you home afterwards.

Risks

Risks of ATI are rare and include:

  • Infection: most of these are minor (1-2%), however can be serious (<0.1%) requiring hospital admission, intravenous antibiotics and surgery.
  • Bleeding: this is fortunately also rare and more common in patients with bleeding disorders and on “blood thinning” medication.  As the body parts treated with ATI are usually superficial, simple pressure, an ice pack, rest and elevation are effective in treating any bleeding.

As the cells are derived from your body, there is no risk of developing side effects, rejection or infectious disease transmission.

Procedure

ATI is a two stage process. Both stages are simple and quick, taking less than 30 minutes each and are well tolerated.

Stage 1

You will be asked to wear a gown, lie down on a couch on your back with the selected area of the body exposed. We will ensure that you are as comfortable as possible. Initially a small specimen of cells is harvested from a normal tendon. The patellar tendon (below the patella, or knee cap) is typically used as it easily accessible and of decent size. An ultrasound examination takes place first in order to confirm that the tendon is normal to guarantee the quality of the specimen. Once this is confirmed, the radiologist will clean your skin with an antiseptic wash and inject local anaesthetic into the skin and soft tissues. This results in a stinging sensation which is temporary until the skin and soft tissues becomes numb, usually taking 10-30 seconds. Under ultrasound guidance, a biopsy needle is used to harvest two small core specimens of the patellar tendon.

The specimens are then placed in a culture medium and grown over a period of several weeks, usually 4- 6 weeks, at the Orthocell biotechnology laboratory in Perth.  This process produces five million healthy tendon cells (tenocytes). Blood will also be drawn from your arm for the purposes of growing your cells in your serum  (the fluid component of your blood). You will then be contacted with respect to the timing of the second injection, at which point, the cells are delivered to Melbourne Radiology Clinic.

Stage 2

The painful tendon to be injected is identified, once again using an ultrasound scanner. The skin is cleansed and anaesthetised as for stage 1. Under ultrasound guidance, the tenocytes are injected safely into painful tendon and into the area of maximal abnormality.


Important information to tell your doctor prior to treatment
Fortunately serious side effects are rare, however if you have an existing condition, this must be discussed with your referring doctor before having this treatment. People with local skin or systemic infections are at greater risk of having an infection spread surrounding soft tissues and joints. Therefore, if you have a skin infection, which may include wounds, boils or rashes, please tell your doctor or arrange to have the procedure performed at a later date.

Following the procedure

At most, you will feel some discomfort in the injected areas. As local anaesthetic has been injected, you will be pain free for several hours. You will be able to walk freely after the procedure and discharged at your leisure. If you do experience pain once the local anaesthetic wears off, simple measures, such as rest for 48 hours, application of a cool compress, taking regular paracetamol and avoiding alcohol, are usually all that are required.

Rehabilitation

  • After the initial 48 hours of rest, you may commence gentle stretching for the first two weeks
  • A rehabilitation programme focusing in eccentric exercises under the supervision of a health professional such as physiotherapist or sports doctor is commenced.

The effects of ATI take several weeks to months to be noticed, which reflects the time taken for the tendon population to regenerate and produce functional and healthy tendon tissue.


Follow-up

The radiologist conducting the injection will send your referring doctor a report.

  • Please ensure that you make a follow up appointment with your referring doctor or health care provider for further treatment follow up

REMEMBER ...

  • Please bring to the clinic, any prior scans (eg. X-rays, ultrasounds, MRI, CT) and reports as these will assist the radiologist in assessing your condition.
  • If you have any further queries please call Melbourne Radiology Clinic on (03) 9667 1667 – we are only too happy to help.
  • Please note that any referral for a scan is valid at Melbourne Radiology Clinic, even if it has been written on a referral form from another radiology provider.

Whilst every effort is made to keep your appointment time, the special needs of complex cases, elderly and frail patients can cause unexpected delays. Your consideration and patience in these circumstances is appreciated.

 

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