Yuji Okuno (Okuno Clinic, Tokyo, Japan) shared with delegate sat the European Conference on Embolotherapy (ET; 21–24 June, Valencia, Spain) an analysis of the best embolization approaches to certain sports injuries associated with overuse.
Okuno began his presentation by defining overuse sports injury as “an injury occurring in the absence of a single, identifiable traumatic cause”. The priorities when it comes to treating these injuries are achieving reliable results and the patient being able to return to their activity quickly, as often, it is high-level athletes who are affected. However, these injuries are usually quite difficult to manage with usual conservative treatment, such as steroid or stem cell injections, and therefore “good indications” for musculoskeletal (MSK) embolization. This is because of the treatment’s minimally invasive nature, which limits patients’ recovery time, Okuno clarified.
Among the overuse sports injuries that can be best treated with embolization, according to Okuno, are tennis elbow, jumper’s knee, Achilles tendonitis, hip pain as a result of hamstring injury, and pain in the lumbar region from spondylolysis. To begin treating these patients, Okuno set out that first, he will evaluate using magnetic resonance imaging (MRI) or ultrasound to “confirm the presence of the hypervascular region”. For the first three types of injury, Okuno shared with delegates that soluble gelatin microspheres (100–300 micrometres)are a good, “safe”, embolic choice. For the hip, lumbar region, and stress fractures, the speaker conveyed how he “always” uses imipenem/cilastatin. A permanent microsphere is an option for tennis elbow or jumper’s knee. During the procedures, Okuno continued, there are two endpoints—the imaging endpoint and the physical endpoint, or the disappearance or decrease in localised “painful tenderness” at the injury site.
A key takeaway Okuno wished to give his audience was that the evidence shows that, when doing lumbar embolization, some particles can cause the nerve root or spinal cord to necrose. This is the case even for some temporary materials. Therefore, imipenem is the only embolic he would recommend.