Effectiveness of Percutaneous Needle Tenotomy for Tendinopathies: A Systematic Review

Context: Tendinopathy is a disease state characterized by tendon disorder with pain or decreased function that 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: To review the current literature of reported outcomes for PNT, TENEX, and TENJET, for the treatment of tendinopathy, including pain relief, change in function, and patient-reported outcomes. Data Sources: A comprehensive search was conducted from database inception to September 2023 in Ovid Medline, Ovid Embase, and Cochrane Library. Study Selection: 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. Study Design: Systematic Review using PICO framework as defined and registered with the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42022321307). Level of Evidence: Level 4 (evidence from a systematic review graded to the lowest level of study included). Data Extraction: Articles meeting the inclusion criteria were reviewed. Type and region of tendinopathy studied, outcome measures, and complications were recorded. Clinical and self-reported outcomes data were compared across studies. Results: A total of 10 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 were 8.35 out of 10 assessing internal and external validity for included studies. Conclusion: PNT and TENEX are safe, beneficial, and minimally invasive treatment option for patients, especially for conditions refractory to more conservative treatments options.