Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic Review

Abstract

Context: Chronic tendinopathy is a challenging problem that can lead to significant disability and limitation in not only athletics but also activities of daily living. While there are many treatment techniques described for this overuse injury, no single modality has been proven superior to all others. With recent advances in medical technology, percutaneous ultrasonic tenotomy (PUT) for tendinosis has gained traction with promising results. Objective: To examine the data published on PUT for treatment of tendinopathy, analyze the outcomes of the procedure, including duration of pain relief and patient-reported outcomes, and assess the rate of complications associated with the procedure. Data Sources: PubMed, MEDLINE, EMBASE, and Google Scholar. Study Selection: The following combination of keywords was entered into the electronic search engines: ultrasonic tenotomy, ultrasound tenotomy, Tenex, and ultrasonic percutaneous tenotomy. The search results were screened for studies relevant to the topic. Only English-language studies were considered for inclusion. Studies consisting of level 4 evidence or higher and those involving human participants were included for more detailed evaluation. Level of Evidence: Level 4. Data Extraction: Articles meeting the inclusion criteria were sorted and reviewed. Type of tendinopathy studied, outcome measures, and complications were recorded. Both quantitative and qualitative analyses were performed on the data collected. Results: There were a total of 7 studies that met the inclusion criteria and quality measures—5 studies involving the treatment of elbow tendinopathy and 1 study each involving the management of Achilles tendinopathy and plantar fasciitis. PUT resulted in decreased pain/disability scores and improved functional outcome scores for chronic elbow tendinopathy and plantar fasciitis. Results for Achilles tendinopathy showed modest improvement in the short term, but long-term data are lacking. Conclusion: PUT is a minimally invasive treatment technique that can be considered in patients with tendinopathy refractory to conservative treatment measures. Further higher quality studies are necessary to accurately assess the comparative effectiveness of this treatment modality.

Emerging Treatment Options for Chronic Tendinopathy of the Foot

“…PUT is achieved by insertion of an 18-gauge ultrasonic vibrating double lumen needle with a suction and irrigation system through a small incision to phacoemulsify diseased tendon tissue. 9 PUT has been previously used successfully in the treatment of tendinopathy at the elbow, hip and pelvis, and knee, with improvement in pain and satisfaction outcomes, as well as in the peroneus brevis tendinopathy with rapid recovery and improvement in pain. 10 However, there is a paucity of literature on use of PUT in the treatment of tendon and ligament of the foot and ankle.…”

“…Given the rationale of healing promotion through controlled inflammation, clinicians have also been leveraging PUT and debridement to promote repair of damaged tendons. PUT is achieved by insertion of an 18-gauge ultrasonic vibrating double lumen needle with a suction and irrigation system through a small incision to phacoemulsify diseased tendon tissue 9 . PUT has been previously used successfully in the treatment of tendinopathy at the elbow, hip and pelvis, and knee, with improvement in pain and satisfaction outcomes, as well as in the peroneus brevis tendinopathy with rapid recovery and improvement in pain 10 .…”

Ultrasound-guided surgery in musculoskeletal medicine

“…PUT is different from other 'release/cutting' procedures in that it uses a novel device called TENEX which was created exclusive to US-guided procedures. According to a systematic review, clinical literature support benefits of PUT for lateral epicondylitis, Achilles tendinosis and plantar fasciopathy [18]. Release/cutting procedures and PUT are described as "second generation" US-guided surgery [6].…”

Interventional Imaging Techniques as Alternative to Surgery of the Foot and Ankle

“…One of the latest advancements for treatment of recalcitrant tendinopathy and plantar fasciitis is percutaneous ultrasonic tenotomy using US-guided debridement with phacoemulsification that can be performed through a small incision. 44 The device (Tenex Health TM system, Tenex Health, Lake Forest, CA) involves phacoemulsification to debride and aspirate diseased tendon tissue using a suction-irrigation system connected to a handheld tool with an ultrasonic vibrating double-lumen needle the size of an 18G needle through a 14G catheter ( Fig. 7 ).…”