The FAST Procedure: How Technology has Changed the Landscape of Tendinopathy

Dr. Joshua Hackel

Orthopedic Design and Technology recently ran a story on the FAST (Focused Aspiration of Scar Tissue) procedure, a new treatment for tendon pain. Up until now, common treatments have comprised a combination of rest, pain medication, cortisone injections, and/or physical therapy to address the pain but not the actual source of pain—the damaged tissue. An open surgical procedure removes the damaged tissue but carries the risk of invasive procedures, including damage to the surrounding healthy tissue and a lengthy recovery time with restricted activity.

Joshus Hackel, M.D., was one of the first doctors in the United States to adopt and use the FAST procedure. He practices at the Andrews Institute Orthopaedics & Sports Medicine in Pensacola, Fla., and talked to ODT about the technology behind the treatment.

The TX1 Tissue Removal System is owned, patented and distributed by Tenex Health, a Lake Forest, Calif.-based company focused on minimally invasive therapies for removal of diseased soft tissue and restoration of healthy musculoskeletal function.

The FAST procedure, designed in collaboration with the Mayo Clinic, is performed using a local anesthetic, allowing patients to remain awake and alert during treatment. Using ultrasound imaging, the scar tissue is identified and the TX1 MicroTip, a small instrument about the size of a toothpick, is inserted into the damaged tendon. Ultrasonic energy then cuts, breaks up and removes the damaged tissue without disturbing surrounding healthy tendon tissue. The procedure typically takes about 15 minutes or less, requires only an adhesive bandage to close the tiny incision, and offers quick recovery time for patients.

The ultrasound waves operate at a high frequency, explained Hackel. The heat generated is ameliorated by saline that the 2-inch micro-tipped needle simultaneously injects and aspirates, cooling the needle while at the same time providing a waterbath with which the degenerative tissue is removed.

The TX1 microtip. Photo courtesy of Tenex Health.

“The technology was originally designed for eye surgery, and was changed slightly to apply it to soft tissue problems and musculoskeletal problems,” Hackel told ODT, adding that the procedure is growing in popularity very quickly because it offers a lasting treatment option for tendinopathy that removes degenerative tissue. “We really didn’t have a great treatment option—until this treatment option.”

None of the past treatment options have been permanent and some methods actually have had adverse effects. “We used to inject corticosteroids into and around the tendon,” said Hackel, indicating the medical community at large, not necessarily himself, “but we found that corticosteroids can degenerate the collagen fibers of tendon and basically make a tendon problem worse. Studies have shown that after three to six months, if you inject tendons with steroids, a majority of patients will return to the office complaining of the same problem.” After the honeymoon period of relief wears off, patients would find themselves in a worse position than they were before.

The TX1 disposable handset. Photo courtesy of Tenex Health.

“Traditional treatment options for tendon-related injuries do not include a quick recovery,” said Hackel. “With the FAST procedure, I am able to change the nature of the disease, and get them back to the activities they love faster than ever before possible.”