Semin Musculoskelet Radiol 2016; 20(05): 414-421
DOI: 10.1055/s-0036-1597545
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound-Guided Percutaneous Tenotomy

Jon A. Jacobson
1   Department of Radiology, University of Michigan, Ann Arbor, Michigan
,
Sung Moon Kim
1   Department of Radiology, University of Michigan, Ann Arbor, Michigan
,
Monica Kalume Brigido
1   Department of Radiology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2016 (online)

Abstract

Of the many treatment options for tendinopathy, percutaneous tenotomy has been used throughout the body with success. With this procedure, a needle is repeatedly passed into the abnormal tendon with the goal of converting a chronic degenerative process to an acute inflammatory condition that will progress to tendon healing. Ultrasound guidance for this procedure is essential to ensure that the abnormal region of the tendon is accurately targeted. The treatment has few contraindications, and negligible complications have been described. This article reviews the rationale behind tenotomy for the treatment of tendinopathy and the ultrasound-guided technique. The current literature comparing the results of tenotomy to other percutaneous tendon treatments is also reviewed, although many of the other tendon injection treatments incorporate tenotomy as part of the procedure.

 
  • References

  • 1 Galloway MT, Lalley AL, Shearn JT. The role of mechanical loading in tendon development, maintenance, injury, and repair. J Bone Joint Surg Am 2013; 95 (17) 1620-1628
  • 2 Aström M, Gentz CF, Nilsson P, Rausing A, Sjöberg S, Westlin N. Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 1996; 25 (7) 615-620
  • 3 Buck FM, Grehn H, Hilbe M, Pfirrmann CW, Manzanell S, Hodler J. Magnetic resonance histologic correlation in rotator cuff tendons. J Magn Reson Imaging 2010; 32 (1) 165-172
  • 4 Khan KM, Bonar F, Desmond PM , et al; Victorian Institute of Sport Tendon Study Group. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Radiology 1996; 200 (3) 821-827
  • 5 Kjellin I, Ho CP, Cervilla V , et al. Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 1991; 181 (3) 837-841
  • 6 Potter HG, Hannafin JA, Morwessel RM, DiCarlo EF, O'Brien SJ, Altchek DW. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology 1995; 196 (1) 43-46
  • 7 Jacobson JA, Lancaster S, Prasad A, van Holsbeeck MT, Craig JG, Kolowich P. Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis. Radiology 2004; 230 (1) 234-242
  • 8 Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol 2012; 41 (4) 369-386
  • 9 Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 2001; 9 (4) 233-238
  • 10 Hartgerink P, Fessell DP, Jacobson JA, van Holsbeeck MT. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology 2001; 220 (2) 406-412
  • 11 Wohlwend JR, van Holsbeeck M, Craig J , et al. The association between irregular greater tuberosities and rotator cuff tears: a sonographic study. AJR Am J Roentgenol 1998; 171 (1) 229-233
  • 12 Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; 376 (9754): 1751-1767
  • 13 Connizzo BK, Yannascoli SM, Tucker JJ , et al. The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent. Clin Orthop Relat Res 2014; 472 (8) 2433-2439
  • 14 Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 2001; 9 (1) 42-47
  • 15 Kim JW, Chun CH, Shim DM , et al. Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication. Knee Surg Sports Traumatol Arthrosc 2011; 19 (7) 1178-1183
  • 16 Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int 1998; 19 (7) 438-446
  • 17 MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252 (3) 647-661
  • 18 Labrosse JM, Cardinal E, Leduc BE , et al. Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR Am J Roentgenol 2010; 194 (1) 202-206
  • 19 Zissen MH, Wallace G, Stevens KJ, Fredericson M, Beaulieu CF. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010; 195 (4) 993-998
  • 20 Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 2013; 309 (5) 461-469
  • 21 Rabago D, Lee KS, Ryan M , et al. Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): results of a single-blind, pilot-level, randomized controlled trial. Am J Phys Med Rehabil 2013; 92 (7) 587-596
  • 22 Carayannopoulos A, Borg-Stein J, Sokolof J, Meleger A, Rosenberg D. Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial. PM R 2011; 3 (8) 706-715
  • 23 Distel LM, Best TM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R 2011; 3 (6) (Suppl. 01) S78-S81
  • 24 Lee KS, Wilson JJ, Rabago DP, Baer GS, Jacobson JA, Borrero CG. Musculoskeletal applications of platelet-rich plasma: fad or future?. AJR Am J Roentgenol 2011; 196 (3) 628-636
  • 25 Kampa RJ, Connell DA. Treatment of tendinopathy: is there a role for autologous whole blood and platelet rich plasma injection?. Int J Clin Pract 2010; 64 (13) 1813-1823
  • 26 Gross CE, Hsu AR, Chahal J, Holmes Jr GB. Injectable treatments for noninsertional Achilles tendinosis: a systematic review. Foot Ankle Int 2013; 34 (5) 619-628
  • 27 Liddle AD, Rodríguez-Merchán EC. Platelet-rich plasma in the treatment of patellar tendinopathy: a systematic review. Am J Sports Med 2015; 43 (10) 2583-2590
  • 28 Mishra AK, Skrepnik NV, Edwards SG , et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med 2014; 42 (2) 463-471
  • 29 Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med 2009; 43 (7) 471-481
  • 30 Sheth U, Simunovic N, Klein G , et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am 2012; 94 (4) 298-307
  • 31 Wang A, Breidahl W, Mackie KE , et al. Autologous tenocyte injection for the treatment of severe, chronic resistant lateral epicondylitis: a pilot study. Am J Sports Med 2013; 41 (12) 2925-2932
  • 32 Krogh TP, Bartels EM, Ellingsen T , et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 2013; 41 (6) 1435-1446
  • 33 Kahlenberg CA, Knesek M, Terry MA. New developments in the use of biologics and other modalities in the management of lateral epicondylitis. Biomed Res Int 2015; 2015: 439309
  • 34 Hoksrud A, Torgalsen T, Harstad H , et al. Ultrasound-guided sclerosis of neovessels in patellar tendinopathy: a prospective study of 101 patients. Am J Sports Med 2012; 40 (3) 542-547
  • 35 Ajibade DA, Vance DD, Hare JM, Kaplan LD, Lesniak BP. Emerging applications of stem cell and regenerative medicine to sports injuries. Orthop J Sports Med 2014; 2 (2) 2325967113519935
  • 36 Hall MM, Rajasekaran S. Ultrasound-guided scraping for chronic patellar tendinopathy: a case presentation. PM R 2016; 8 (6) 593-596
  • 37 He L, Genin J, Delzell P. Ultrasound diagnosis and percutaneous treatment of Achilles tendon tethering: a case series. Skeletal Radiol 2016; 45 (9) 1293-1298
  • 38 Seng C, Mohan PC, Koh SB , et al. Ultrasonic percutaneous tenotomy for recalcitrant lateral elbow tendinopathy: sustainability and sonographic progression at 3 years. Am J Sports Med 2016; 44 (2) 504-510
  • 39 Chiavaras MM, Jacobson JA. Ultrasound-guided tendon fenestration. Semin Musculoskelet Radiol 2013; 17 (1) 85-90
  • 40 Jacobson JA, Rubin J, Yablon CM, Kim SM, Kalume-Brigido M, Parameswaran A. Ultrasound-guided fenestration of tendons about the hip and pelvis: clinical outcomes. J Ultrasound Med 2015; 34 (11) 2029-2035
  • 41 McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med 2006; 25 (10) 1281-1289
  • 42 Godfrey EM, Godfrey AL, Perry DJ, Shaw AS. Don't be a clot: a radiologist's guide to haemostasis including novel antiplatelet and anticoagulant therapies. Clin Radiol 2011; 66 (8) 693-700
  • 43 Goldenberg NA, Jacobson L, Manco-Johnson MJ. Brief communication: duration of platelet dysfunction after a 7-day course of Ibuprofen. Ann Intern Med 2005; 142 (7) 506-509
  • 44 Foremny GB, Pretell-Mazzini J, Jose J, Subhawong TK. Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature. Skeletal Radiol 2015; 44 (5) 619-627
  • 45 Sherman T, Ferguson J, Davis W, Russo M, Argintar E. Does the use of ultrasound affect contamination of musculoskeletal injections sites?. Clin Orthop Relat Res 2015; 473 (1) 351-357
  • 46 Sung CM, Hah YS, Kim JS , et al. Cytotoxic effects of ropivacaine, bupivacaine, and lidocaine on rotator cuff tenofibroblasts. Am J Sports Med 2014; 42 (12) 2888-2896
  • 47 Housner JA, Jacobson JA, Morag Y, Pujalte GG, Northway RM, Boon TA. Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases. Clin J Sport Med 2010; 20 (6) 488-490
  • 48 Mautner K, Stafford II CD, Nguyen P. Ultrasound-guided distal bicep tendon injection using a posterior approach. PM R 2015; 7 (9) 1007-1010
  • 49 McShane JM, Shah VN, Nazarian LN. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary?. J Ultrasound Med 2008; 27 (8) 1137-1144
  • 50 Stenhouse G, Sookur P, Watson M. Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma. Skeletal Radiol 2013; 42 (11) 1515-1520
  • 51 Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013; 41 (3) 625-635
  • 52 Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 2009; 28 (9) 1187-1192
  • 53 Jacobson JA, Yablon CM, Henning PT , et al. Greater trochanteric pain syndrome: percutaneous tendon fenestration versus platelet-rich plasma injection for treatment of gluteal tendinosis. J Ultrasound Med 2016; 35: 2413-2420
  • 54 Kanaan Y, Jacobson JA, Jamadar D, Housner J, Caoili EM. Sonographically guided patellar tendon fenestration: prognostic value of preprocedure sonographic findings. J Ultrasound Med 2013; 32 (5) 771-777
  • 55 Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med 2014; 42 (3) 610-618
  • 56 de Vos RJ, Weir A, Cobben LP, Tol JL. The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study. Am J Sports Med 2007; 35 (10) 1696-1701
  • 57 Richards PJ, Win T, Jones PW. The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler. Skeletal Radiol 2005; 34 (6) 336-342
  • 58 Zanetti M, Metzdorf A, Kundert HP , et al. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US. Radiology 2003; 227 (2) 556-560