Tenex Percutaneous Tenotomy Procedure Guidelines
Tendinopathy is a clinical condition characterized by pain and dysfunction related to mechanical loading of the tendon. It is a chronic overuse injury. Chronic tendon pain is due to a progressive breakdown of collagen fibers; characterized by collagen disorganization, paradoxical ingrowth of nerve endings, and in some cases integration of calcium into the tendon fibers. While most tendinopathies respond well to conservative treatment, a small subset of tendinopathies are recalcitrant and require more invasive treatment. Minimally invasive ultrasound guided mechanical treatments have shown favorable results such as percutaneous needle tenotomy.
The basic principle of percutaneous needle tenotomy is to stimulate a healing response within a region of disorganized non-healing tendon tissue via local acute trauma produced by multiple needle fenestrations. The Tenex Health TX system (Tenex Health, Lake Forest, CA) is an ultrasonic cutting instrument designed to debride (or remove) the unhealthy tendon fibers without adversely affecting the healthy fibers. Tenex can remove pathologic tissue and stimulate an acute process, introducing inflammatory growth factors thus promoting healing of the tendon. Recent advances in the Tenex Health TX system include the TX-2 and TX-bone device which can now remove hard calcifications and even small bone spurs without having to undergo a surgical procedure where a long surgical incision is required. Furthermore, the minimally invasive procedure allows for less post-procedure pain and faster recovery than traditional surgical approaches.
Percutaneous tenotomy and debridement with Tenex Health TX System is always performed using ultrasound guidance to accurately target the diseased tendon tissue with precision to maximize safety and efficacy. Occasionally, more than one incision/entry site is required to effectively target the pathologic tissue. Upon completion of the procedure, a small adhesive bandage is used to close the incisional wound followed by a gauze and transparent film dressing. A compression sleeve may be used in some cases. Post-procedure rehabilitation will vary slightly by the site, the severity of injury, and functional goals of the patient. The duration of rehabilitation period varies but typically takes between 6 to 12 weeks to return to activities.