carlos leal md - acadèmia de ciències mèdiques i de la ... · 80-90% good & excellent 5% -...
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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
PRE 1
SES
INM
EDIA
TO
PRE 2
SES
INM
EDIA
TO
1 SEM
2 SEM
1 M
ES
3 M
ES
6 M
ES
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
0 10 20 30 40 50 60 70 80 90
VA
S /1
00
PRE-ESWT
POST ESWT
2 SEM 1 MES 3 MES 6 MES 12 MES 18 MES 24 MES
ESWT PATELAR 85 22 31 25 18 20 25 20 28
ESWT PATELLAR
0
10
20
30
40
50
60
70
80
90
100
PRE-ESWT 1 MES 3 MES
6 MES 12 MES
18 MES 24 MES
VIS
A
SC
OR
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
0
10
20
30
40
50
60
70
80
90
TIME
VA
S S
CA
LE
ESWT
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
0
10
20
30
40
50
60
70
80
TIME
% O
F P
AT
IE
NT
S
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
0
10
20
30
40
50
60
70
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
10
20
30
40
50
60
WANG ONDAS PEERS
ONDAS SCHADEN ONDAS LEAL ONDAS
WANG FISIO PEERS
CIRUGIA
VA
RIA
CIO
N V
AS
& 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
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