TAME embolization for chronic joint and tendon pain: what it is and what the evidence shows

The idea behind TAME

Chronic joint and tendon pain is often more than wear and tear. Long-standing inflammation can make the lining of a joint or the attachment of a tendon grow tiny abnormal new blood vessels (neovessels), and nerve fibres grow along with them. These vessels feed the inflammation and the pain. The idea behind TAME is to close these small arteries from the inside, so that the blood flow that sustains the inflammation falls and pain settles. Early work in tendinopathy used a temporary embolic made from the antibiotic imipenem/cilastatin, and permanent or resorbable microspheres are also used ^{[1, 2]}.

How the procedure is done

TAME is usually done as a day-care procedure and takes 45 to 90 minutes.

• Before the procedure, your pain is assessed and X-rays or MRI confirm the diagnosis and rule out other causes. Kidney function is checked for the contrast dye.
• Under local anaesthetic, a catheter enters an artery at the groin or wrist (rarely a foot or ankle artery) and is guided to the small arteries around the painful joint or tendon under X-ray.
• Contrast dye shows a 'blush' of abnormal vessels at the painful site.
• A microcatheter is placed in those small branches, and tiny particles or a temporary agent are injected until the blush disappears.
• The catheter is removed, a dressing is placed and you walk out the same day.

Conditions covered, and what is known

Each condition has its own guide. In all of them, standard treatment comes first and embolization is considered only after it has failed.

Who may be considered

TAME is considered for people with a clear diagnosis, pain that significantly limits life, and no adequate improvement after at least three months of proper conservative treatment. It is not suitable if you have an active infection, a serious allergy to contrast dye, poor kidney function that rules out dye, pregnancy, or significant artery disease in the limb. Pain from another cause, such as a pinched nerve, or advanced joint destruction needing replacement, should be identified first.

Risks and side effects

Reported effects are mostly minor and temporary: bruising or a small haematoma at the puncture site (about 3% in one pooled analysis), pain or tenderness for a few days, and skin discolouration over the treated area (about 11% in the same analysis), which settles ^[3]. Rare serious problems from closing a non-target artery are possible, and an artery blockage after plantar fasciitis embolization has been reported ^[7]. Your doctor explains these before you consent.

What we do not yet know

Many of the studies have no control group, so some of the benefit may reflect the placebo effect and the natural course of the condition. Sham-controlled trials of knee embolization so far are small, with short follow-up ^[4]. We do not yet know which embolic material is best, how long benefit lasts, or exactly who responds best. Honest counselling matters: this is a promising option for carefully selected people, not a guaranteed cure.

Cost and insurance

The cost depends on the procedure, the embolic material used and the day-care facility, and is explained after consultation and a review of your scans. Because these treatments are newer, insurance cover varies between policies and is checked before the procedure, and it is never assumed. Please ask the team for the specifics of your policy.