Sonographically Guided Patellar Tendon Fenestration: Prognostic Value of Preprocedure Sonographic Findings

Kanaan, Yassine; Jacobson, Jon A.; Jamadar, David A.; Housner, Jeffrey A.; Caoili, Elaine M.

doi:10.7863/ultra.32.5.771

Cited by 13 publications

(15 citation statements)

References 26 publications

(29 reference statements)

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“…To date, the predictive value of sonography after needle tenotomy in elbow epicondylopathies has not been explored. However, in the patellar tendon, clinical outcomes were improved in tendons with well‐defined areas of tendinosis compared with tendons with ill‐defined areas 4 weeks after tenotomy …”

Section: Discussionmentioning

confidence: 98%

“…However, there is some confusion regarding the procedure and associated terminology. In general, tenotomy, fenestrations and needling are considered synonymous and described as 20‐50 needle‐passes through the tendon . Going deeper, other authors described two different needle tenotomy modalities, including the so‐called peppering technique, which involves less tendon fenestrations (approximately five needle passes), and a more aggressive needle tenotomy involving multiple abrasions until tissue softening.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Martín

Atilano

Merino

et al. 2019

PM&R

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Background Elbow tendinopathies are associated with tenderness, pain, and functional disability with ensuing socioeconomic costs. There is lack of consensus regarding the best treatment for patients recalcitrant to first‐line conservative treatments. Percutaneous needle tenotomy is considered a regenerative approach that injures the tendon to elicit a healing response. Objective To investigate whether demographic characteristics, clinical factors, baseline sonographic entities, or their interactions are related to the likelihood of responding positively to needle tenotomy over a 1‐year follow‐up period. Design Prospective case series. Setting Tertiary institutional hospital. Participants Patients with elbow tendinopathy for whom conservative treatments had failed and who had persistent symptoms lasting for at least 3 months. Methods Patients underwent needle tenotomy with or without PRP followed by a lighter needle tenotomy within a 2‐week interval as part of treatment. Main Outcome Measurements Disabilities of the Arm, Shoulder and Hand (DASH) and Visual Analogue Scale for pain (VAS‐P) scores were assessed before intervention (baseline) and at 6 weeks and 3, 6, and 12 months after intervention. A generalized linear mixed effects model was created to examine whether injectate type, clinical, demographic, or pretreatment sonographic entities or their interactions influenced clinical outcomes. Results The authors analyzed 74 elbows (71 patients). At baseline, analyzed patients (mean age: 49.48 years; 51.35% women) scored 43.30 and 5.83 on the DASH and VAS‐P, respectively. Pretreatment tendon vascularization was a predictor of pain (P = .011) and DASH score changes (P = .019). The linear mixed effect model revealed that male gender and hypercholesterolemia were associated with enhanced functional recovery, (P = .020 and P < .001, respectively). Moreover, the interactions between pretreatment vascular status (P = .039), echotexture (P = .037) and enthesophytes (P = .028) influenced the temporal pattern of functional recovery after needle tenotomy. Conclusions Baseline patient characteristics, such as gender and hypercholesterolemia, along with ultrasound features may be predictive of outcomes following needle tenotomy for elbow tendinopathy. Level of Evidence IV (NCT01945528).

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Martín

Atilano

Merino

et al. 2019

PM&R

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“…Although studies have shown patient improvement after ultrasound-guided tendon fenestration, there are only limited studies evaluating fenestration of gluteal tendons, and there are no studies comparing gluteal tendon fenestration to other tendon treatments such as PRP injection. [9][10][11][12][13][19][20][21] Although a comprehensive review of PRP treatment is beyond the scope of this discussion and has previously been described in the literature, PRP involves centrifuging autologous venous blood to separate the platelet-rich layer, which can then be injected into an abnormal tendon to promote healing. 14,22,23 Similar to tendon fenestration but in a higher concentration, growth factors are released from α granules in platelets to promote tendon healing.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound-guided percutaneous needle fenestration (or tenotomy) has been used to effectively treat underlying tendinosis and tendon tears, including tendons about the hip and pelvis. [9][10][11][12][13] The rationale behind tendon fenestration is that a chronic degenerative tendon process is converted to an acute process, and inherent growth factors are introduced with bleeding, thereby promoting tendon healing. 10 Similarly, autologous platelet-rich plasma (PRP), often combined with tendon fenestration, has been used throughout the body to treat tendinosis and tendon tears, as injection into a tendon promotes healing via the introduction of growth factors concentrated in and released from platelets.…”

mentioning

confidence: 99%

Greater Trochanteric Pain Syndrome

Jacobson

Yablon

Henning

et al. 2016

J of Ultrasound Medicine

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“…With respect to sclerosing treatments, immunohistochemical analyses of tendon biopsies from hypervascular regions have shown nerves located close to blood vessels, which is possibly why ultrasoundguided sclerosing treatments have been effective (17 -20). In addition, treatment by ultrasound-guided patellar tendon fenestration or arthroscopic shaving has also been reported (17,18,21).…”

Section: State-of-the-art Ultrasonographic Findings In Lower Extremitmentioning

confidence: 99%

State-of-the-art ultrasonographic findings in lower extremity sports injuries

et al. 2015

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: Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, SindingLarsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular, and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes.

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Sonographically Guided Patellar Tendon Fenestration: Prognostic Value of Preprocedure Sonographic Findings

Cited by 13 publications

References 26 publications

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

Greater Trochanteric Pain Syndrome

State-of-the-art ultrasonographic findings in lower extremity sports injuries

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