Musculoskeletal embolotherapy is fast emerging as a potential treatment option for many degenerative and sports related conditions. Find out more about this fast paced new field…
By Prof. Mark W. Little
Musculoskeletal (MSK) embolization is the next frontier in interventional radiology. Millions of patients live in chronic daily pain as a result of osteoarthritis (OA), tendinopathy, and enthesopathy.
Over the last decade, in-vivo studies have identified neo-angiogenesis as a pivotal factor in the pathogenesis of these conditions. The realisation that neo-angiogenesis can be exploited as an embolization target, has resulted in an exponential growth in MSK embolotherapy research. There is data elucidating the potential of emboloisation in the treatment of knee OA, plantar fasciitis, patellar tendinopathy, frozen shoulder, hand OA, and even chronic lumbar back pain.
As with any intervention designed to treat pain, the placebo effect must be considered. Future work must address this by designing sham controlled trials. Future work is also required on the choice of embolic agent. At the current time, interventional radiologists in the Far East are using Imipenem and Cilastatin, which is an antibiotic that has temporary embolic properties in blood. Whilst the data using Imipenem is extremely encouraging, the antibiotic is not licenced as an embolic agent in the West. This has limited research and reduced generalisability in end organ territories such as Achilles tendiniopathy and hand OA where non-target embolization with permanent embolic agents may cause significant adverse events.
The potential and scope of MSK embolotherapy is extremely exciting and may provide a new treatment strategy for the many patients who have failed to respond to conservative therapy, but do not have a surgical option.