Percutaneous Ultrasonic Tenotomy Research Articles

Structural and Clinical Outcomes after Tenex Debridement for Rotator Cuff Tendinopathy

Background Rotator cuff tendinopathy (RCT) is a frequently encountered condition by the orthopedic surgeon. Patients presenting with tendinopathy or partial thickness tear present a difficult challenge to treat. Treatments for rotator cuff tendinopathy include nonsurgical and surgical intervention. While surgical management can be effective in the treatment of RCT, patients must be willing to accept risks of anesthesia and surgery and be willing to potentially undergo a lengthy post-operative rehabilitation course. Our study evaluates the use of percutaneous ultrasonic debridement (percutaneous ultrasonic tenotomy (PUT)) of tendinopathy lesions for rotator cuff tendinopathy. Methods This study consisted of 15 patients with symptomatic rotator cuff pathology diagnosed by physical exam and magnetic resonance imaging (MRI). Operative and non-operative treatment options for RCT were discussed with the patients, including the Tenex procedure. The 15 patients who underwent the Tenex procedure were followed post-procedure for clinical improvement with Shoulder Pain and Distability Index (SPADI) scores and for structural improvement with MRI. Results The present study included 15 patients (16 shoulders) consisting of 8 women and 7 men. The average age of our cohort was 59.9. 14 of the patients achieved improvements in their SPADI (Shoulder Pain and Disability Index) scores and had similar or improved structural appearance on MRI after undergoing percutaneous ultrasonic debridement. Conclusion The results from this study show that patients with RCT who have tried conservative treatment but are not interested in surgical intervention can consider the Tenex procedure. The procedure carried a high safety profile with significant improvement in outcomes in the majority of patients.

Ultrasound Percutaneous Tenotomy: An Intervention for Managing Lateral Epicondylitis: A Narrative Review

A growing emphasis is being focused on percutaneous ultrasonic tenotomy for expedited recovery from lateral epicondylitis (LE) and enhanced functionality. The TX1 tissue removal system, also known as the Tenex device from Tenex device (Tenex Health Inc., Lake Forest, CA, USA), notably excels in the management of chronic LE. Utilizing ultrasonic energy, this device offers three tips, namely, TX1, TX2, and TXBone-introducing novel avenues, for determining the previously inaccessible tendon pathology. The procedure disrupts degenerated segments, which creates fenestrations that induce local hemorrhage and the release of vasoactive substances. The overarching goal of Tenex is to boost vascularity through the initiation of tendon repair via the deposition of new collagen and elimination of necrotic tissues. This review assesses Tenex’s effectiveness though gathering information, aiming to understand how it helps doctors and other healthcare professionals in their work.

Greater Trochanteric Pain Syndrome (GTPS): A clinical prospective study of treatment options

Background: There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). There is a diversity of available interventions and lack of clear consensus for the best modality thus far. Design: Observational prospective cohort study performed during the period of October 2017 and March 2019. Methods: The main objective was to determine if there is a difference in outcome of the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT). Participants were assigned based on physician treatment in a non-randomized manner to PT, a single CSI, or the PUT treatment arm. Subjects participated in outcome assessments at baseline and at 1-, 3-, 6-, and 12-months post intervention. Results: 112 individuals with unilateral GTPS were recruited for this study with 69 PT patients, 31 CSI patients, and 12 PUT patients. The adjusted mean LEFS scores averaged across all time periods remained statistically different between PT, CSI, and PUT (p = 0.0093), indicating significant difference between each treatment arm. PT group saw the greatest improvements from baseline score starting at 1 month and up to 1 year (p = .0004). CSI group did not see significant LEFS improvement until 6 months (p = 0.04) and did not maintain clinically significant improvement by 1 year. PUT group saw significant LEFS improvement at 3 months (p = 0.0001) and maintained clinically significant improvements (≥ 9 LEFS points) throughout the course of the study. Conclusion: PT patients over the study period showed the greatest improvements in LEFS scores compared to CSI and PUT patients. We believe that PT is the best indicated course of treatment for GTPS. PUT may be considered as an additional option if patients have failed other treatment modalities. CSI shows benefit at 6 months, but overall inferior to PT and PUT.

Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic Review.

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. 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. PubMed, MEDLINE, EMBASE, and Google Scholar. 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 4. 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. 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. 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.

Current Treatments of Insertional Achilles Tendinopathy

This paper aims to review the pathophysiology, diagnosis, and treatment of insertional Achilles tendinopathy (IAT). There is no current consensus regarding conservative or surgical treatments for IAT. There has recently been an increase of trials demonstrating utility for extracorporeal shock wave in treating IAT. Additionally, a retrospective study of percutaneous ultrasonic tenotomy shows promise. IAT has historically been recalcitrant to treatment. There are multiple available treatment options, and many that may confer some benefit. Knowing the available conservative treatment options and discussing the risks and benefits with the patient can help the patient and clinician determine what treatment options to employ for each individual.

Percutaneous ultrasonic tenotomy with the TX-1 device versus surgical tenotomy for the treatment of common extensor tendinosis.

To compare outcomes in patients treated for chronic common extensor tendinosis with percutaneous ultrasonic tenotomy (TX-1 device) versus surgical tenotomy. Outcomes from consecutive patients who underwent percutaneous tenotomy with the TX-1 device were compared with outcomes from consecutive patients who underwent surgical tenotomy. Patients were contacted to retrospectively assess their outcomes at 4 time points: before treatment, 2weeks after treatment, 3 to 6months after treatment, and 12months after treatment. Outcomes were assessed using the quick disabilities of the arm, shoulder, and hand score (QuickDASH) and the Oxford elbow score (OES). Student's t tests were used to compare postprocedural versus preprocedural scores and percutaneous versus surgical tenotomy scores. Response rates were 23 of 43 and 10 of 47 for surveyed percutaneous and surgical tenotomy patients, respectively. There were significant improvements from preprocedural scores in all primary outcome measures at 3-to-6-month and 12-month time points for both procedures. No significant changes from preprocedural scores were seen for either procedure at 2weeks after treatment or between percutaneous and surgical tenotomy in preprocedural or postprocedural scores for any outcome measure. At 2weeks, improved percutaneous tenotomy scores approached significance compared with percutaneous preprocedural QuickDASH (p = 0.060) and surgical 2-week OES function domain (p = 0.074) scores. Ultrasonic percutaneous tenotomy with the TX-1 device and surgical tenotomy have similar outcomes for chronic common extensor tendinosis, with significant symptomatic improvement occurring after 3 to 6months. Larger studies are needed to assess for differences at 2weeks.

Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy.

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.

Myths and Facts of In-Office Regenerative Procedures for Tendinopathy.

Tendinopathy carries a large burden of musculoskeletal disorders seen in both athletes and aging population. Treatment is often challenging, and progression to chronic tendinopathy is common. Physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections have been the mainstay of treatment but are not optimal given that most tendon disorders seem to involve degenerative changes in addition to inflammation. The field of regenerative medicine has taken the forefront, and various treatments have been developed and explored including prolotherapy, platelet rich plasma, stem cells, and percutaneous ultrasonic tenotomy. However, high-quality research with standardized protocols and consistent controls for proper evaluation of treatment efficacy is currently needed. This will make it possible to provide recommendations on appropriate treatment options for tendinopathy.

Percutaneous Ultrasonic Tenotomy Reduces Insertional Achilles Tendinopathy Pain With High Patient Satisfaction and a Low Complication Rate.

Due to the novelty of percutaneous ultrasonic tenotomy, the risks and benefits of this minimally invasive procedure for insertional Achilles tendinopathy pain have only been examined in case studies and retrospective chart reviews for other diagnoses. This retrospective chart review over a 3.5-year period identified 34 patients with insertional Achilles tendinopathy who had percutaneous ultrasonic tenotomy (mean age ± SD, 52.2 ± 11.6 years; mean body mass index, 32.9 ± 7.5 kg/m2 ; 62% female). This procedure reduced the rate of moderate/severe pain from 68% at baseline to 15% at the long-term follow-up and had a satisfaction rate of 70%. There was 1 minor complication out of 40 procedures in 34 patients.

Efficacy of Percutaneous Ultrasonic Ablation of Soft Tissue (Tenex) in Tendinopathy and Fasciopathy

Percutaneous ultrasonic ablation of soft tissue, otherwise known as percutaneous ultrasonic tenotomy (PUT) and percutaneous ultrasonic fasciotomy (PUF), has been utilized in the past several years for the treatment of chronic recalcitrant tendinopathy and fasciopathy. Recent studies have begun to investigate the efficacy of this procedure. In a limited number of case series, patients with chronic recalcitrant tendinopathy and fasciopathy do well following percutaneous ultrasonic ablation with improvement in pain and functional scores. In studies investigating the elbow, there is evidence of ultrasonic resolution of diseased tissue years following the procedure. Overall, despite intriguing findings to date, there is very limited evidence for use of percutaneous ultrasonic ablation in the treatment of tendinopathy or fasciopathy. While the evidence for the use of PUT and PUF presented in this review is intriguing, randomized, placebo-controlled trials are needed to truly determine efficacy.

Poster 163 Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy Following Failed Open Surgical Release: A Case Report.

Poster 163 Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy Following Failed Open Surgical Release: A Case Report.

Current Concepts and the Role of Surgery in the Treatment of Jumper's Knee.

Jumper's knee is a common cause of anterior knee pain among athletes and active populations. Numerous treatments have been described with variable results. To better delineate this, the authors reviewed all articles from 2000 to 2014 pertaining to the treatment of patellar tendinopathy, focusing namely on treatment of recalcitrant cases. Open and arthroscopic techniques were found to achieve similar satisfactory results in 81% (range, 45%-100%) and 91% (range, 86%-96%) of patients, respectively. Average time to return to play was 5.6 months and 5 months, respectively. A recently described technique, percutaneous ultrasonic tenotomy, potentially represents an attractive alternative option for definitive intervention. [Orthopedics. 2016; 39(6):e1028-e1035.].

Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy

Background: A previously published study found positive outcomes for a novel technique for ultrasound-guided percutaneous ultrasonic tenotomy, showing good tolerability, safety, and early efficacy within an office setting. Purpose: In this follow-up study, all 20 members of the original cohort were contacted after 3 years to explore the sustainability of symptomatic relief, functional improvement, and sonographic soft tissue response for percutaneous ultrasonic tenotomy. Study Design: Case series; Level of evidence, 4. Methods: All 20 subjects of the clinical trial that was performed from June to November 2011 were further assessed at 36 months after the procedure in terms of visual analog scale for pain, Disabilities of the Arm, Shoulder and Hand (DASH)–Compulsory/Work scores, need for adjunct procedures, and overall satisfaction. Importantly, all 20 were reassessed with ultrasound imaging at 36 months, and evidence of the common extensor tendon response was assessed in terms of tendon hypervascularity, tendon thickness, and the progress of the hypoechoic scar tissue. Results: A 100% clinical follow-up was achieved, inclusive of ultrasonographic assessment. None of the subjects required further treatment procedures, and 100% expressed satisfaction. Previous improvements in visual analog scale (current median ± SD, 0 ± 0.9; range, 0-3) and DASH-Work scores (current median, 0 ± 0) were sustained with conformity to a linear pattern on polynomial measures. There was further reduction in DASH-Compulsory scores to a median of 0 ± 0.644 (range, 0-2) with a significant decrease on repeated measures (P = .008). Tendon hypervascularity was resolved in 94% of patients, and 100% had reduction in tendon thickness. Overall reduction in the hypoechoic scar tissue was observed in all subjects, with a 90% response achieved by 6 months. Between 6 and 36 months, further reduction in the scar was observed in around 60% of patients, with 20% of patients having complete resolution of the hypoechoic scar. Conclusion: Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. It is one of the few procedures to demonstrate positive sonographic evidence of tissue-healing response and is an attractive alternative to surgical intervention for definitive treatment of recalcitrant elbow tendinopathy.

Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study

Elbow tendinopathy is the most common cause of elbow pain affecting active populations. Surgical excision is reserved for patients with refractory symptoms. Percutaneous ultrasonic tenotomy performed under local anesthesia also removes degenerated tissue and therefore provides an alternative treatment option to surgical excision. This investigation prospectively documented the safety and 1-year efficacy of ultrasonic percutaneous tenotomy performed by a single operator. Nineteen patients, aged 38 to 67years, in whom >6months of conservative management for medial (7) or lateral (12) elbow tendinopathy had failed were prospectively studied. All patients were treated with percutaneous ultrasonic tenotomy of the elbow by a single operator. Visual analog scale (VAS) for pain, the 11-item version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) index, and the Mayo Elbow Performance Score (MEPS) were assessed by an independent observer before treatment and at 6weeks, 3months, 6months, and 12months after treatment. No procedural complications occurred. Total treatment time was <15minutes, and ultrasonic energy time averaged 38.6 ± 8.8seconds per procedure. Average VAS scores were significantly improved from 6.4 to 2.6 at 6 weeks and were 0.7 at 12 months (P<.0001). Similar improvement occurred with the Quick DASH (pretreatment, 44.1; 12 months, 8.6, P<.0001) and MEPS (pretreatment, 59.1; 12 months, 83.4; P<.0001). Percutaneous ultrasonic tenotomy performed under local anesthesia appears to be a safe and effective treatment option for chronic, refractory lateral or medial elbow tendinopathy up to 1 year after the procedure.

CORR Insights®: Does the use of ultrasound affect contamination of musculoskeletal injections sites?

This CORR Insights® is a commentary on the article “Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites? by Sherman and colleagues available at: DOI: 10.1007/s11999-014-3903-4. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®. This CORR Insights® comment refers to the article available at DOI: 10.1007/s11999-014-3903-4.

Percutaneous Ultrasonic Tenotomy as a Treatment for Chronic Patellar Tendinopathy—Jumper’s Knee

Chronic patellar tendinopathy is often a debilitating process markedly affecting athletic performance and even routine daily activities. Treatment that is at once reliable, safe, effective and with rapid recovery has not, to date, been available. An early two year experience with a percutaneous tenotomy , performed under local anesthia, using ultrasound energy appears to effectively address these desirable treatment goals.