What is the Tenex Procedure for Lateral Epicodylitis?

Tenex is cutting device used to perform minimally invasive tenotomy procedures under ultrasound guidance. The Tenex device is designed to cut and remove damaged tendon tissue by inserting the device into the affected area through a tiny incision, breaking down and suctioning out the degenerated tissue while preserving healthy structures. This method is designed to accelerate healing and reduce post-procedure pain compared to open surgery [Altahawi et al, 2021].

What is Surgical Tenotomy for Lateral Epicodylitis?

A traditional surgical tenotomy makes a larger incision to access the tendon. The typical size of the surgical incision for an open tenotomy is 2 to 3 cm. This incision size allows adequate exposure for the manual excision of the damaged tissue, and sometimes reattaching or repairing the tendon [Wolf, 2023; Leppilahti et al, 2001]. Traditional surgical approaches can be performed as either open or arthroscopic surgery.

• Open Tenotomy: This traditional approach involves resection of pathologic tissue and sometimes drilling the bone of the lateral epicondyle to improve blood supply. Long-term follow-up studies have shown significant improvement in pain and elbow function scores, with extensor strength similar to the nonoperative arm. However, complications such as inadvertent injury to the lateral ulnar collateral ligament can occur [Wolf, 2023].
  
• Arthroscopic Tenotomy: Arthroscopic tenotomy for lateral epicondylitis has been shown to provide symptomatic relief similar to an open tenotomy. In a randomized controlled trial comparing arthroscopic and open surgery, the authors found no significant differences in patient-reported outcomes, grip strength, or complications at 12 months. In another study, an arthroscopic tenotomy resulted in a shorter return-to-activity when compared to an open tenotomy [Wolf, 2023; Coleman et al, 2000].
  

Effectiveness: How Do They Compare?

A recent study by Altahawi et al. comparing an ultrasound guided tenotomy using the Tenex TX-1 device to a traditional open surgical tenotomy for lateral epicondylitis. The findings indicate that both procedures effectively reduced pain and improved function, but the Tenex procedure offered several advantages, including:

• Faster Pain Relief: Patients undergoing the Tenex procedure reported faster pain relief when compared to patients who had the traditional surgical tenotomy.
• Faster Functional Improvement: The patients who had the tenotomy using the Tenex device reached peak recovery earlier, although at 6-months both groups had a similar improvement in grip strength and daily function.
  
• Similar Long-Term Outcomes: The study demonstrated that the tenotomy procedure performed with Tenex had similar long-term outcomes to traditional surgery, making the Tenex procedure a viable alternative to traditional open surgery.

Recovery Time: A Key Factor for Patients

One of the biggest advantages of Tenex over surgery is the recovery timeline.

• Tenex: Patients typically resume light activities within days and return to full function within 4-6 weeks. Since the procedure does not involve sutures and preferentially targets damaged tissue only, it allows for a faster return to work and sports.
• Surgical Tenotomy: Recovery can take several months. The average time of immobilization after surgery for tennis elbow (lateral epicondylitis) varies depending on the surgical technique used.
  
  • For open surgical tenotomy, patients typically require immobilization for
    approximately 2 to 4 weeks postoperatively to allow initial healing and reduce strain on the repaired tendon [Lattermann et al, 2010; Oki et ala, 2014; Lemmens et al, 2023].
  • Patients can require an extended period of physical therapy and gradual reintroduction to activity. The average duration of physical therapy after surgery for tennis elbow (lateral epicondylitis) typically ranges from 3 to 6 months. This period involves a structured rehabilitation program aimed at restoring range of motion, strength, and function.
  • The time required for a gradual return to activity varies, but most patients can expect to resume regular activities within 6 to 12 weeks postoperatively. Full return to high-demand activities or sports may take longer, often around 3 to 6 months, depending on the extent of the surgery and the patient's adherence to the rehabilitation protocol [Lattermann et al, 2010; Oki et ala, 2014; Lemmens et al, 2023; Soeur et al, 2016].
    

Risks and Complications

While both procedures have risks, Tenex is generally associated with fewer complications [Altahawi et al, 2021]:

• Tenex Risks: Minor swelling, bruising, and mild discomfort are common but typically resolve in 1-2 weeks.
• Surgery Risks: Infection, nerve damage, scarring, and longer post-operative pain.
  

How does Tenex Compare to Surgery for Tennis Elbow?

Who is the Best Candidate for Tenex for Lateral Epicondylitis?

• Ideal Candidates for Tenex:
  • Patients with chronic lateral epicondylitis unresponsive to conservative treatments
  • Those seeking a minimally invasive procedure with a quicker recovery
  • Athletes or workers who need a faster return to activity

Is Tenex the Future of Tennis Elbow Treatment?

For many patients, Tenex offers a promising alternative to surgical tenotomy. With faster recovery, lower risk of complications, and comparable long-term outcomes [Altahawi et al, 2021]. Learn more at:

(781) 591-7855

info@BSBortho.com

20 Walnut St

Suite 14

Wellesley MA 02481

References:

1. Altahawi F, Li X, Demarest B, Forney MC. Percutaneous ultrasonic tenotomy with the TX-1 device versus surgical tenotomy for the treatment of common extensor tendinosis. Skeletal Radiol. 2021 Jan;50(1):115-124.
2. Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian Institute of Sport Tendon Study Group. Am J Sports Med. 2000 Mar-Apr;28(2):183-90.
3. Lattermann C, Romeo AA, Anbari A, Meininger AK, McCarty LP, Cole BJ, Cohen MS. Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg. 2010 Jul;19(5):651-6.
   
4. Lemmens L, De Houwer H, van Beek N, De Schrijver F. Functional recovery in the surgical treatment of tennis elbow: side-to-side vs. tendon-to-bone attachment using a knotless suture anchor: a randomized controlled trial. J Shoulder Elbow Surg. 2023 Apr;32(4):751-759.
   
5. Leppilahti J, Raatikainen T, Pienimäki T, Hänninen A, Jalovaara P. Surgical treatment of resistant tennis elbow. A prospective, randomised study comparing decompression of the posterior interosseous nerve and lengthening of the tendon of the extensor carpi radialis brevis muscle. Arch Orthop Trauma Surg. 2001 Jun;121(6):329-32.
6. Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. 2014 Oct;23(10):1527-31.
   
7. Soeur L, Desmoineaux P, Devillier A, Pujol N, Beaufils P. Outcomes of arthroscopic lateral epicondylitis release: Should we treat earlier? Orthop Traumatol Surg Res. 2016 Oct;102(6):775-80.
   
8. Wolf JM. Lateral Epicondylitis. N Engl J Med. 2023 Jun 22;388(25):2371-2377.