Carlos Leal MD Artroscopia, Rodilla & Traumatología del Deporte Universidad El Bosque Bogota

Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper’s knee. Clin North Am. 1973;4:665-678. Colosimo AJ, Bassett FH. Jumper’s knee: diagnosis and treatment. Orthop Rev. 1990;19:139-149. Eifert-Mangine M, Brewster C, Wong M, Shields C Jr, Noyes FR. Patellar tendinitis in the recreational athlete. Orthopedics. 1992;15:1359-1367

Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. / Scand J Med Sci Sports. 2000;10:2-11. Fritschy D, Wallensten R. Surgical treatment of patellar tendinitis. / Knee Surg Sports Traumatol Arthrosc. 1993;1:131-133. Griffiths GP, Selesnick FH. Operative treatment and arthroscopic findings in chronic patellar tendonitis. / Arthroscopy. 1998;14:836-839.

Maier M, Steinborn M, Schmitz C, et al. Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: prediction of outcome by magnetic resonance imaging. J Rheumatology. 2000;27:2455-2462. Rompe JD, Joellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendonitis of the shoulder. Clin Orthop Relat Res. 2001;387:72-82.

Wang CJ, Wang FS, Yang KD, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J // Orthop Res. 2003;21:984-989. Leal CA. Insertional Tendinitis: Basic Sciences and clinical approach with ESWT Transactions of the Aspen Foundation for Sports Medicine and Research, Aspen Colorado U.S.A., September 13-14, 2002

Wang CJ, Wang FS, Yang KD, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J // Orthop Res. 2003;21:984-989. Leal CA. Insertional Tendinitis: Basic Sciences and clinical approach with ESWT Transactions of the Aspen Foundation for Sports Medicine and Research, Aspen Colorado U.S.A., September 13-14, 2002

Wess O, Leal CA, Cortes M, Schaden W Biocirugia por Ondas de Choque: Principios Basicos y Tecnologia, Revista de la Sociedad Latinoamericana de Artroscopia y Traumatología del Deporte, Organo Oficial del Colegio Mexicano de Ortopedia, Artroscopia y Cirugia de Rodilla, y de la SETRADE, Sociedad Española de Medicina del Deporte, Vol4 – Num.4/ 8-17, Dic 2007 Ching-Jen Wang, Jih-Yang Ko, Yi-Sheng Chan, Lin-Hsiu Weng and Shan-Lin Hsu Extracorporeal Shockwave for Chronic Patellar Tendinopathy // Am. J. Sports Med. 2007; 35; 972

Universidad El Bosque Postgrado de Ortopedia y Traumatologia Fundación Santa Fé de Bogotá Departamento de Ortopedia y Traumatología

Epicondilo48%

Plantar17%

Patelar9%

Aquiles10%

Hombro10%

Epitroclea3%

Trocanter3%

TENDINOPATIAS TOTAL

80-90% Good & Excellent

5% - 10% Recurrence

Leal CA, López JC, Reyes OE. Ondas de Choque en Ortopedia y Traumatología. Revista de la Sociedad Colombiana de Cirugía Ortopédica y Traumatología, VXI#2, 42-52, 2002 Rompe JD, Joellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendonitis of the shoulder. Clin Orthop Relat Res. 2001;387:72-82. Wang CJ, Yang KD, Chen HS, Wang FS, Wang JW. Shock wave therapyfor calcifying tendonitis of the shoulder. // Am J Sports Med. 2003; / 31:425-430

ESCALA VISUAL ANALOGA

TENDINITIS ROTULIANA Y ESWT

012345678

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INM

EDIA

TO

PRE 2

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2 SEM

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3 M

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6 M

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TIEMPO

ES

CA

LA

VA

S

DIURNO

NOCTURNO

PALPACION

Wess O, Leal CA, Cortes M, Schaden W Biocirugia por Ondas de Choque: Principios Basicos y Tecnologia, Revista de la Sociedad Latinoamericana de Artroscopia y Traumatología del Deporte, Organo Oficial del Colegio Mexicano de Ortopedia, Artroscopia y Cirugia de Rodilla, y de la SETRADE, Sociedad Española de Medicina del Deporte, Vol4 – Num.4/ 8-17, Dic 2007 Ching-Jen Wang, Jih-Yang Ko, Yi-Sheng Chan, Lin-Hsiu Weng and Shan-Lin Hsu Extracorporeal Shockwave for Chronic Patellar Tendinopathy // Am. J. Sports Med. 2007; 35; 972

ESWT

-Device: BTL 5000 POWER RSWT - Energy: 4000 Shockwaves @ 0.03 to 0.1 mJ/mm2 - Dose: Two Sessions - Anesthesia: No - Focus: Proximal insertion PT

METHODS

Leal CA, López JC, Herrera JM, Reyes OE. Shockwave Surgery and Autologous Growth Factors Combined Therapy 8Th International Congress of the International Society for Musculoskeletal Shockwave Therapy Vienna, Austria, Mayo 29 a Junio 1º de 2005

PROTOCOLO FENWAY ONDAS EN TENDINOPATIAS.pdf

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VA

S /1

00

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ESWT PATELAR 85 22 31 25 18 20 25 20 28

ESWT PATELLAR

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6 MES 12 MES

18 MES 24 MES

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E

PRE-ESWT 1 MES 3 MES 6 MES 12 MES 18 MES 24 MES

ESWT PATELAR 36 76 82 78 86 92 90

ESWT PATELAR

EXCELENTE BUENO REGULAR MALO

37

24 22 17

52

29

11 8

Radial Vs. EHD en ESWT Patelar

RADIAL EH-DIGITAL

%

EV Resultados

ESWT in Patellar Tendinopathies

…our worst cases…

2005 PILOT STUDY ESWT & PRP COMBINED THERAPY 10 volunteers Over10 months of unsuccessful treatment Booked for surgery

MRI lesions < 10mm

ESWT & PRP Together ??

METHODS

AGF

- Type: Autologous platelet derived - Blood sample: 50cc - Dose delivered: 10cc - Activator: Calcium & Thrombin - Injection: Ultrasound assisted - Intralesional

Leal CA, López JC, Herrera JM, Reyes OE. Shockwave Surgery and Autologous Growth Factors Combined Therapy 8Th International Congress of the International Society for Musculoskeletal Shockwave Therapy Vienna, Austria, Mayo 29 a Junio 1º de 2005

VAS Pain Assesment

RESULTS

VAS PAIN SCALE PATELLAR TENDON ESWT

VS ESWT&AGF

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ESWT & AGF

ESWT 79 65 54 44 27 32

ESWT & AGF 74 55 22 16 14 11

PRE TX

POST TX

1 MO 2 MO 3 MO 6 MO

Leal CA, López JC, Herrera JM, Reyes OE. Shockwave Surgery and Autologous Growth Factors Combined Therapy 8Th International Congress of the International Society for Musculoskeletal Shockwave Therapy Vienna, Austria, Mayo 29 a Junio 1º de 2005

RESULTS

RETURN TO SPORT

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TIME

% O

F P

AT

IE

NT

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ESWT

ESWT & AGF

ESWT 12 16 28 32

ESWT & AGF 10 30 60 70

1 MO 2 MO 3 MO 6 MO

Leal CA, López JC, Herrera JM, Reyes OE. Shockwave Surgery and Autologous Growth Factors Combined Therapy 8Th International Congress of the International Society for Musculoskeletal Shockwave Therapy Vienna, Austria, Mayo 29 a Junio 1º de 2005

RESULTS

FUNCTIONAL OUTCOME SCALES

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80

90

TIME

% O

F P

ATIEN

TS

ESWT

ESWT & AGF

ESWT 12 34 45 55

ESWT & AGF 20 60 60 80

1 MO 2 MO 3 MO 6 MO

Leal CA, López JC, Herrera JM, Reyes OE. Shockwave Surgery and Autologous Growth Factors Combined Therapy 8Th International Congress of the International Society for Musculoskeletal Shockwave Therapy Vienna, Austria, Mayo 29 a Junio 1º de 2005

0

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WANG ONDAS PEERS

ONDAS SCHADEN ONDAS LEAL ONDAS

WANG FISIO PEERS

CIRUGIA

VA

RIA

CIO

N V

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& V

ISA

@ 2

AÑ

OS

WANG ONDAS PEERS ONDAS SCHADEN

ONDAS LEAL ONDAS WANG FISIO PEERS CIRUGIA

REDUCCION VAS 55 46 60 57 12 38

MEJORIA VISA 51 38 54 54 4 31

Título del gráfico

The American Journal of Sports Medicine, Vol. 35, No. 6, Mar, 2007

Wess O, Leal CA, Cortes M, Schaden W Biocirugia por Ondas de Choque: Principios Basicos y Tecnologia, Revista de la Sociedad Latinoamericana de Artroscopia y Traumatología del Deporte, Organo Oficial del Colegio Mexicano de Ortopedia, Artroscopia y Cirugia de Rodilla, y de la SETRADE, Sociedad Española de Medicina del Deporte, Vol4 – Num.4/ 8-17, Dic 2007 Ching-Jen Wang, Jih-Yang Ko, Yi-Sheng Chan, Lin-Hsiu Weng and Shan-Lin Hsu Extracorporeal Shockwave for Chronic Patellar Tendinopathy // Am. J. Sports Med. 2007; 35; 972

Wess O, Leal CA, Cortes M, Schaden W Biocirugia por Ondas de Choque: Principios Basicos y Tecnologia, Revista de la Sociedad Latinoamericana de Artroscopia y Traumatología del Deporte, Organo Oficial del Colegio Mexicano de Ortopedia, Artroscopia y Cirugia de Rodilla, y de la SETRADE, Sociedad Española de Medicina del Deporte, Vol4 – Num.4/ 8-17, Dic 2007 Ching-Jen Wang, Jih-Yang Ko, Yi-Sheng Chan, Lin-Hsiu Weng and Shan-Lin Hsu Extracorporeal Shockwave for Chronic Patellar Tendinopathy // Am. J. Sports Med. 2007; 35; 972

Wess O, Leal CA, Cortes M, Schaden W Biocirugia por Ondas de Choque: Principios Basicos y Tecnologia, Revista de la Sociedad Latinoamericana de Artroscopia y Traumatología del Deporte, Organo Oficial del Colegio Mexicano de Ortopedia, Artroscopia y Cirugia de Rodilla, y de la SETRADE, Sociedad Española de Medicina del Deporte, Vol4 – Num.4/ 8-17, Dic 2007 Ching-Jen Wang, Jih-Yang Ko, Yi-Sheng Chan, Lin-Hsiu Weng and Shan-Lin Hsu Extracorporeal Shockwave for Chronic Patellar Tendinopathy // Am. J. Sports Med. 2007; 35; 972

Wess O, Leal CA, Cortes M, Schaden W Biocirugia por Ondas de Choque: Principios Basicos y Tecnologia, Revista de la Sociedad Latinoamericana de Artroscopia y Traumatología del Deporte, Organo Oficial del Colegio Mexicano de Ortopedia, Artroscopia y Cirugia de Rodilla, y de la SETRADE, Sociedad Española de Medicina del Deporte, Vol4 – Num.4/ 8-17, Dic 2007 Ching-Jen Wang, Jih-Yang Ko, Yi-Sheng Chan, Lin-Hsiu Weng and Shan-Lin Hsu Extracorporeal Shockwave for Chronic Patellar Tendinopathy // Am. J. Sports Med. 2007; 35; 972

Conclusion

Surgery

Arthroscopy

Ondas de choque

AGF

Toxina Botulinica

Physical Therapy

NSAIDS - Injections

Risk Factor and Mechanical Loading Control Bracing

Surgery

Arthroscopy

Shockwave Medicine

Physical Therapy

NSAIDS - Injections

Risk Factor and Mechanical Loading Control Bracing

Conclusion

Surgery

Arthroscopy

Shockwave Medicine

Physical Therapy

NSAIDS - Injections

Risk Factor and Mechanical Loading Control Bracing

Approved Standard Indications

Chronic tendinopathies:

Plantar fasciitis with or without heel spur (best evidence!)

Achilles tendon

Radial epicondylopathy (tennis elbow)

Rotator cuff with or without calcification (best evidence!)

Patella tendon

Greater trochanteric pain syndrome

Impaired bone healing function:

Delayed bone healing, pseudarthrosis (best evidence!)

Stress fractures (best evidence!)

Early stage of avascular bone necrosis (native X-ray without pathology)

Early stage osteochondritis dissecans (OD) post-skeletal maturity

1998 - Izmir / Turkey 1999 – London 2000 - Naples 2001 – Berlin 2002 – Winterthur 2003 – Orlando 2004 – Kaoshiung 2005 – Vienna 2006 – Rio de Janeiro 2007 – Toronto 2008 – Juan Les Pins 2009 – Sorrento 2010 – Chicago 2011 – Hamburg 2012 - Cartagena

15th Congress of the International Society for Medical Shockwave Treatments

Cartagena, Colombia July 4-7, 2012

Informacion e Inscripciones

www.onlat.org

Gracias !