Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy

Abstract

Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described. Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months). Results: The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 ( P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 ( P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) ( P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures. Conclusion: PUT is an effective treatment, with good results for patients with gluteal tendinopathy.

Ultrasonic Tenotomy and Debridement for Calcific Tendinopathy of the Shoulder: A Pilot Case Series

“…Ultrasonic tenotomy and calcific deposit removal with Tenex Health Devices (TX1, TX2, TXBone) is a technique that has been available since 2011 and has previously shown to be safe and effective for treatment of tendon disorders throughout the body with minimal adverse events reported. 12,16,19 For example, Baker and Mahoney presented a similar case series demonstrating comparable improvements in pain scores in 29 patients with gluteal tendinopathy. Barnes et al performed ultrasonic tenotomy for common flexor and common extensor tendinosis of the elbow in 19 patients with significant reductions in Visual Analogue Scale and QuickDASH scores at one year post-procedure and no complications.…”

“…Ultrasonic tenotomy and debridement of tendinopathy across multiple tendons in the body is a novel treatment option that has been previously shown to be an effective treatment option for the common extensor tendon of the elbow, 12 - 15 Achilles tendon, 16 , 17 patellar tendon, 18 gluteal tendon 19 and biceps tendon 20 among other areas. 21 , 22 A common device used, manufactured by Tenex ( Tenex Health, Lake Forest, CA ) utilizes ultrasonic energy to debride and aspirate pathologic tendon tissue.…”

“…10 Recent meta-analysis found that ultrasound-guided lavage was more effective than extracorporeal shockwave treatment or a corticosteroid injection with clinically important effect in the short term, but questionable long term results. 9 Complications from calcific tendinopathy can include pain, adhesive capsulitis, rotator cuff tears, greater tuberosity osteolysis and ossifying tendinitis as outlined in the review by Merolla et al 11 Ultrasonic tenotomy and debridement of tendinopathy across multiple tendons in the body is a novel treatment option that has been previously shown to be an effective treatment option for the common extensor tendon of the elbow, [12][13][14][15] Achilles tendon, 16,17 patellar tendon, 18 gluteal tendon 19 and biceps tendon 20 among other areas. 21,22 A common device used, manufactured by Tenex (Tenex Health, Lake Forest, CA) utilizes ultrasonic energy to debride and aspirate pathologic tendon tissue.…”

Percutaneous ultrasound‐guided resection of a painful osteophyte using novel Tenex‐Bone device in a residual limb: A case report

“…14 The TX1 and TX2 MicroTips been used to remove diseased tendon, while one case series removed both scar tissue and bone in non-healing diabetic foot ulcers. [7][8][9][10][11][12] In August of 2018, The TX-Bone cutting device that was specifically designed to remove osseous and calcific tissue received FDA 510 (k) clearance to remove pain-causing bone. This device requires a small 2-3 mm incision that in theory would limit wound-related complications.…”

“…Additionally, the Tenex cutting device has been studied as a treatment for chronic diabetic foot ulcers. [7][8][9][10][11][12]…”