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.

Keywords: systematic review; tendinopathy; tendinosis; tendonitis; tenex; ultrasonic tenotomy.

Figure 1.

Search algorithm used to select studies for inclusion using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines.

Figure 2.

Improved pain and disability scores after Tenex procedure. DASH, Disabilities of the Arm, Shoulder and Hand; Postop, postoperative; Q-DASH, Quick-DASH (11-item version of the DASH); VAS, visual analogue scale.

Figure 3.

Improved functional scores pre- and post-Tenex. ASES, American Shoulder and Elbow Surgeons; MEPS, Mayo Elbow Performance Score; postop, postoperative.