The BIOS Orthopedic Institute

Alberto J. Panero, D.O.

Regenerative Orthopedics Specialist & Sports Medicine Specialist located in Sacramento, CA

The pain of an inflamed tendon, known as tendinitis, can be debilitating. Come see Dr. Alberto J. Panero at The BIOS Orthopedic Institute in Sacramento, California, to get relief. He uses the Tenex procedure as a minimally invasive way to treat tendon pain. You’ll have a quick recovery so you can get back to your game, sport, or daily activities sooner.

The Tendon Injury Spectrum:

Tendonitis – Tendinopathy – Partial vs Full Tendon Tear
Tendons are cords of connective tissue that attach muscles to bones. When they become irritated, it can result in pain ranging from a dull burning ache to a sharp cutting pain. Tendonitis occurs at the site of the inflammation and can involve the surrounding area. You’ll likely lose some range of motion and function in the affected joints. The most common parts of the body affected by tendinitis are:

  • Base of the thumb
  • Elbow
  • Shoulder
  • Hip
  • Knee
  • Bottom of the foot
  • Achilles tendon

Repetitive movement is a common cause of tendinitis or tendinopathy. Sports such as tennis or softball (pitching) that have you moving in the same way over and over are often responsible. Habitual ways of sitting or doing daily chores, such as scrubbing or raking, put you at risk, too. An injury can also lead to tendinopathy or tearing of the tendon. Tendons have a difficult time healing on their own as they have poor blood supplies and are constantly at high load.

Tendonitis is typically inflammation and swelling of the tendon without much structural injury.
Tendinopathy has very little inflammation and instead has diffuse thickening of the tendon with loss of collagen quality and mechanical properties.
Partial Tear: Some of the fibers can be torn, but the tendon remains attached to and to a certain degree in continuity between the muscle and bony insertion. Partial tears of 50% or less the size of the tendon may be healed with interventional orthopedic treatments.
Full Tear: no fibers remain in continuity. These typically need surgery in order to fix them.
It is important to be able to recognize the specific type of pathology as the treatments will vary depending on the type of tendon problem.

What Tendon conditions can we treat at B.I.O.S?

Our state of the art orthobiologic and interventional orthopedic treatments like PRP, Bone marrow concentrate can address an array of tendon conditions. These include:

  • Calcific tendonitis
  • Rotator cuff tendinopathy
  • Tennis and golfer’s elbow
  • Patellar tendinopathy
  • Achilles tendinopathy
  • Plantar fasciitis

How do we use orthobiologics like Platelet Rich Plasma (PRP), Bone Marrow Concentrate (BMC) , micro-fragmented adipose, and amnion scaffolds to heal tendons?

Platelet Rich Plasma (PRP) is efficacious at treating tendonitis and tendinopathy. In fact, there are multiple level 1 studies supporting its use in lateral epicondylitis (tennis elbow) and gluteal tendinopathy. The platelets release growth factors and cytokines that kick start the body’s healing response in the area, leading to better collage formation, decrease in inflammation and pain.

For more advanced tendinopathy or partial tendon tears, PRP may not be strong enough to heal the tendon. Thus, we recommend the use of stronger biologics like BMC along with a scaffold to optimize the outcome. For instance, if there is a partial tear in the rotator cuff or Achilles tendon, we will first inject a scaffold of micronized adipose or an amnion membrane to “stick” to the tear. Then we inject the BMC which contains a higher concentration of growth factors and mesenchymal stem cells into and around the scaffold that is within the tear. This ensures that the BMC stays within the tear and can maximize healing at the site of injury. It is also worth noting that the micronized adipose and/or amnion membrane have their own healing properties that act as a bio-inductive agents, further maximizing the healing at the site of tendon tear.

What is the Tenex procedure?

The Tenex procedure is a superior, minimally invasive treatment option for tendon pain. Developed in conjunction with the Mayo Clinic, it uses ultrasonic energy to cut and remove diseased tendon tissue. It’s designed to cut through diseased tissue only, as it’s not strong enough to cut through or damage healthy tissue.  With the use of musculoskeletal ultrasound, Dr. Panero guides the Tenex MicroTip precisely to the injured area, providing optimal benefit.

The procedure is typically covered by most insurance companies, with prior authorization.

Why is the Tenex procedure better than surgery?

The Tenex procedure offers significant advantages over surgery. No sutures or stitches are needed, which means less time required for healing. Tenex is performed under local anesthesia, so you won’t be exposed to the physical trauma and health risks of general anesthesia. The Tenex procedure does very little damage to healthy tissue because it involves no heat or cauterizing. The whole procedure is less painful than any surgery and allows you to return to your normal activities quickly.

How about combining orthobiologics PRP/BMC with Tenex?

For certain cases like advanced tendinopathy or interstitial tearing, using tenex to first cut through and clean out the disease portion of the tendon to prepare the tissue to receive the biologics makes sense. This can typically be done at the same time and in combination with each other. The recommendation is to do Tenex first and augment it with either PRP or with BMC and a scaffold with microfragmented adipose or an amnion sheet.

Injection options for Tendinopathy

  • Tenex Procedure: The Tenex device contains a special micro-tip that oscillates at ultrasonic speed to break up diseased tendon tissue and vacuums it out. The micro-trauma also creates an inflammatory response that promotes tendon healing. Please visit tenexehealth.com for detailed information. This procedure is typically covered by insurance, with prior authorization
  • Platelet Rich Plasma (PRP) Injections: Blood is taken from your arm and is spun down to get the healthiest healing factors – platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. A one time leukocyte rich, concentrated PRP injection is recommended. 1 injection may be all you need, however, there are times where multiple injections may be provide additional benefit. Not covered by insurance. Costs $875 per injection.
  • Mesenchymal “Stem Cell” Injections -Recommended for advanced tendinoapthy or partial tendon tears. Bone marrow is aspirated from the back of your pelvis and centrifuged in a special kit to concentrate the “stem cells”. A small amount of adipose (fat) is aspirated as well to create a small graft. The adipose graft is the injected into the tear to act as as scaffold. The bone marrow concentrate is then injected into the scaffold within the tear. Alternatively, an amnion sheet can be used as a scaffold. “stem cells” can be obtained from fat through lipoaspiration. The goals are to change the living micro-environment of the tendon, up regulating collagen formation, and promote tendon cell healing and re-organization. Goal is to help repair and restore the structure of the Not covered by insurance. Costs $4500 per injection.

Finally after 3 months of being brushed off, I found a Doctor who cared to take an extra minute to treat me as an individual and listen. I saw several doctors without a diagnosis and I now have that and a plan of care. Truly grateful for Dr . Panero!!! Very Thorough.

Davina R.

Initial consultation went well. Looking forward to the next few appts to get back to total health.

Andy W.

I was very happy with Dr. Panero. He took his time to listen to me and evaluate me. Then he went over all my options and answered all my questions. I am very glad I was referred to him!

David M.

Dr. Panero is an amazing physician who truly cares about the wellbeing of his patients. His entire team is dedicated, thorough, and professional who makes sure all appointments go smoothly even with the ongoing pandemic. Dr. Panero recommended PRP for my elbow tendinitis and truly advocated for me to get the treatment I needed to improve my chronic pain. I am so grateful to be one of Dr. Panero’s patients!

Rena S.

Very personable and knowledgeable presenting options for the problem and then going forward from the choice made. I would definitely recommend him to friends and family! Office staff is fabulous as well.

Jim M.