Fellow Physician Cleveland Clinic Cleveland, Ohio, United States
Objectives: Tendinopathy is a disease state characterized by tendon disorder with pain or decreased function, which can cause significant disability. Multiple treatment modalities exist; however, no single treatment is superior. Ultrasound-guided Percutaneous Needle Tenotomy (PNT) and TENEX are emerging as promising treatment options for tendinopathy. Objective is to review the current literature of reported outcomes for PNT and TENEX, for the treatment of tendinopathy, including pain relief, change in function, and patient-reported outcomes.
Design: A Systematic Review using PICO framework as defined and registered within the International Prospective Register of Systematic Reviews was performed (PROSPERO ID CRD42022321307). A comprehensive search was conducted from database inception to September 2023 in Ovid Medline, Ovid Embase, and Cochrane Library. Keywords and index terms related to tendon injury, ultrasound, and tenotomy were used in combination to identify relevant literature that included ultrasound-guidance, treatment of tendinopathy, and treatment with PNT, TENEX, or TENJET. Covidence Systematic Review Software used to screen for relevant studies. Only English-language studies were included.
Results: Level I evidence from a systematic review of all relevant RCTs is reported. Twenty studies, representing 11 tendon sites, were included. The studies overall report improvements in pain, function, and quality of life after undergoing PNT or TENEX, with minimal adverse effects. Mean risk of bias assessment scores, as defined by the National Institute for Health Research and National Health Service Centre for Reviews and Dissemination, were 8.35 out of 10 assessing internal and external validity for included studies.
Conclusions: PNT and TENEX are safe, beneficial, and minimally invasive treatment options for patients, especially for conditions refractory to more conservative treatments options. Currently, most studies involve treatment of the lateral elbow, medial elbow, and gluteal tendons.
