The Regenerative Spine and Joint Institute (RSJI) offers the most advanced, personalized, precision and science based regenerative medicine intervention, for the treatment of tendon and ligament related conditions. Our approach and treatment decisions are based on the evaluation of the Patient Regenerative Index, (a proprietary classification of your body’s ability to heal), in conjunction with the Regenerative Ligament/Tendon Index (a proprietary classification of the joint state of degeneration).

We utilize The B.E.T.R System with Bio-Cellular Therapies, which is an accurate, reproducible, comprehensive and science-based system. B.E.T.R. was developed based on the principles of Biologic Enhancement of Tissue Repair, which defines our ultimate treatment goal. By utilizing specific biologic tissue engineering techniques, we can successfully treat early to the advanced degenerative tendon and ligament conditions.



What is the B.E.T.R. Bio-Stem Tendon/Ligament

Is an advanced, proprietary biologic tissue engineering system designed to enhance the process of tendon and ligament repair and regeneration. There are two main types of tendon/ligament procedures and they are named according to the specific biologic tools used.

This technique is used initially to treat patients with symptomatic tendon/ligament conditions who are having mild to moderate symptoms and have minimal degenerative changes . It consists of injecting a combination of substances called Biologic Stimulants into the tendon and ligaments. These stimulants, contain powerful growth factors (substances which stimulates multiple cell functions) capable of producing significant improvement in function and tissue repair. Biologic Stimulants can be highly successful and cost effective in patients with early symptomatic degenerative or traumatic tendon and ligament conditions.
See Biologic Stimulant Therapies

B.E.T.R Stem Tendon/Ligament

This system was designed for patients who have failed the above interventions or have moderate to advanced symptomatic degenerative or traumatic tendon and ligament conditions It consists of using proprietary tissue engineering techniques injecting tendons and ligaments with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with moderate to advanced degenerative or traumatic tendon and ligament conditions.
See Bio-Cellular Grafts Therapies

Who is a candidate for Bio-Stem Tendon/Ligament therapy?

Patients with painful degenerative or traumatic tendon and ligament lesions who have failed conservative therapy and or surgical procedures. The best candidates have early to moderated/advanced changes, with partial or incomplete tears or tendinosis. This procedure is not recommended in patients with complete tendon or ligament tears .. In other words, if the tendons or ligaments are completely separated from the bone or muscle, a surgical intervention is most likely indicated. Frequently, once the surgical repair is performed, the Bio-Stem therapy can be used to enhance the outcome and recovery period.

What type of tendon and ligament conditions can be treated with the Bio-Stem Tendon Ligament therapy?

Almost any tendon and ligament with partial tears or tendinosis can be treated, however the most common conditions are:

  • Shoulders: Rotator Cuff Tears, Shoulder Instability, Bicep Tears
  • Elbow: Tennis Elbow, Golfers Elbow, Collateral Ligament Tears
  • Knee: Jumpers Knee, Collateral Ligament and Cruciate Ligaments Tears
  • Ankle: Chronic Instability, Achilles Tendon Tears and Tendinosis
  • Foot: Plantar Fasciitis
  • Hip: Psoas Tendinosis/Tear, Hamstring Tears, Quadriceps Tears
  • Sacroiliac Joint: Instability and Pain
  • Head and Neck: Whiplash, Occipital Headaches
  • Low Back: Lumbar Sprains and Ligament Laxity

How is the procedure performed?

The procedure is performed in our state of the art facility. Local anesthesia with intravenous sedation is utilized, in order to facilitate relaxation and assist in comfort. Also an intravenous antibiotic will be administered prior to the procedure. You will be taken to the procedure suite, place in the surgical bed lying on your stomach or back depending on the type of technique. Blood pressure and cardiac monitors will be applied.

According to the type repair, you may undergo a bone marrow aspiration (from your iliac crest) or lipoaspirate grafting (from abdominal or flank adipose tissue)in order to obtain mesenchymal mesenchymal stem cells. For patients undergoing Biologic Stimulant Therapies or Amniotic Tissue Grafts, the procedure is usually performed under local anesthesia with no need for intravenous antibiotics.

Next, the skin overlying the respective areas are will be cleansed with special sterilizing solutions. Then a solution of local anesthetic (numbing medication) is infiltrated in the skin and deeper tissues overlying the tendons or ligaments. Under sonographic guidance (ultrasonography) a special needle is inserted into the respective tendons or ligaments. You may feel temporary discomfort during this time. Afterwards, the specific tissue graft or biologic stimulant is carefully injected with a proprietary technique. The needle is then removed, bandages applied and the patient is taken to the post procedure suite.

After the procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications will be given post procedure to assist in managing any discomfort. The post procedure discomfort is usually minor and can be manage with ice packs and medications. However, some patients require stronger pain medications when advanced grafting has been performed.
See Bio-Cellular Regenerative Interventions


Tenex Taxonomy Image 2Tenex Taxonomy Image 1

What Is a Percutaneous Tenex Tenotomy?

It is the most advanced minimally invasive intervention performed under ultrasound guidance (sonogram), utilized in the treatment of chronic tendon problems known as tendinosis or tendinopathy, with or without tendon tears. A small skin incision is performed under local anesthesia and the Tenex device is inserted into the enlarged, damaged tendon, ultimately creating debridement and removal of the damaged tissue.

What is the Tenex Device?

Is a device designed for precise cutting of the diseased tissue involving the fascia or tendon, using ultrasonic energy. It targets precise areas involved with tendinopathy and fasciitis. This device is an alternative to other surgical cutting instruments such as scalpels, low frequency electro cautery, coblation and others used for this purpose.

What is the advantage of the Tenex Tenotomy?

The Tenex Tenotomy is minimally invasive, extremely precise, cost effective, has minimal morbidity, fast recovery and the results are compelling.

When Is the Procedure Indicated?

Most of the time, tendon related problems can be treated conservatively. Usually physical therapy, orthotics, proper training methods, adequate rest, analgesics and rehabilitation, can improve or resolve the symptoms altogether. When conservative therapy fails and there is significant pain and loss of function, a percutaneous Tenex Tenotomy should be considered.

Which Are the Most Commonly Treated Conditions?

Rotator Cuff Tears, Tennis Elbow, Golfer|‘s Elbow, Plantar Fasciitis, Trochanteric Bursitis-Tendinosis, Achilles Tendinopathy, others.

The Procedure

Usually the procedure is performed under intravenous sedation with local anesthetic supplementation. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, blood pressure and cardiac monitors will be applied. Next, the respective tendon area will be scrub and cleansed in a sterile fashion. With ultrasound guidance, local anesthetic is injected in the skin and deep tissues. Then a small incision is made and the Tenex device is advanced under ultrasound guidance until the Tenex device is in the optimal area. The tenotomy and debridement is performed for approximately 2 minutes. After the procedure is performed a biologic fibrin glue with growth factors (platelet rich plasma) is injected to enhance tissue healing and regeneration.

After the Procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications prescribed for the post -operative period may include: an antibiotic or opioid analgesic. The post procedure discomfort is usually minor and can be manage with ice packs and medications. Rehabilitation protocols will be specific to the specific tendons treated and usually start within one week post procedure.

Is Tenex Tenotomy covered by medical insurance plans?

Most insurance companies routinely provide coverage, however this can vary from state to state and within the same company. Our office will provide with the necessary information prior to the procedure.
See Bio-Cellular Regenerative Interventions


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What Is Prolotherapy?

First, it is important to understand what the word prolotherapy itself means. (Prolo) is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.

Prolotherapy consists of the injection different substance in soft connective tissue such as ligaments and tendon, to induced tissue healing and regeneration.

Ligaments are the structural (rubber bands) that hold bones to bones in joints. Ligaments can become weak or injured and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore, the person will feel pain at the areas where the ligaments are damaged or loose.

Tendons are the name given to tissues which connects muscles to bones, and in the same manner tendons may also become injured, causing pain.

What types of medications are utilized in Prolotherapy?

Traditionally very irritating substances such as phenol were combined with Dextrose (medical grade liquid sugar) and injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas, which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

Recently with the evolving knowledge of bio-mechanics and regenerative medicine, other medications are being successfully such as: Testosterone, Peptides (IGF-!), Cytokines (Traumeel), Ozone and PRP (platelet rich plasma). The decision on which specific medication is used is dependent on many factors and decided on an individual basis.

Historical review shows that a version of this technique, was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the joint, and it would then miraculously heal normally. Of course, we don|‘t use hot pokers today, but the principle is similar: get the body to repair itself, utilizing the body|‘s innate healing ability.

What type of conditions can benefit from Prolotherapy?

The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, ligaments and cartilage, TMJ, sciatica, and degenerated or herniated discs.

How Long Will It Take to Complete a Course of Treatments?

The response to treatment varies from individual to individual, and depends upon one|‘s healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. Once you begin treatment, your doctor can gage how you are responding and give you an accurate estimate.

What happens during the procedure?

The injection is performed in the examination room or the procedure suite (if you are having a different procedure). The procedure is usually performed under local anesthesia. However, some interventions require light intravenous sedation for enhanced comfort. You will be examined under sonography (ultrasound imaging) or fluoroscopy (X ray) depending on the type of injection. The skin area will be sterilized with alcohol or betatine and numb with a local anesthetic. A small needle is then inserted into the specific site and a specific volume of the medication is injected.

After the Procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 15-60 minutes according to your response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. Post procedure instructions will be given in a pre-printed form. It can take as long as three weeks before the full benefit from the Rhizotomy can be noticed. It is not advisable that you drive the day of the procedure.

Is Prolotherapy covered by medical insurance plans?

Most insurance companies consider Prolotherapy investigational and thus not a covered procedure. Our office will assist you with separate financial arrangements.