What is percutaneous ultrasonic tenotomy?
Percutaneous ultrasonic tenotomy (PUT) is a minimally invasive technique as an alternative to surgery. Ultrasonic energy is emitted from the end of a needle device that helps to debride and aspirate abnormal tissue. It is based on the same principle as cataract surgery and is an FDA-authorized device to treat orthopedic related soft tissue conditions using debridement and aspiration. This technology was developed in collaboration with the Mayo Clinic and has been FDA-cleared since 2012. Since that time, over 65,000 procedures have been completed.
Ultrasonic energy rapidly oscillates the tip of a hollow needle to break down abnormal tissue which is removed by a dual outflow and inflow tract circuit using sterile saline solution. Basically, an inner tube vibrates when activated with an oscillatory frequency of 28 KHz, which allows targeted debridement and aspiration of diseased soft tissue.
Percutaneous ultrasonic tenotomy has been shown in multiple clinical trials to be a safe and effective treatment that can be accomplished in an outpatient setting under local anesthesia. A 3-year follow-up study looking at tennis elbow has shown significant improvement in pain and function in addition to imaging evidence (using ultrasound) of tendon healing.
Who may benefit?
If you have been experiencing continued pain from a chronic tendon disorder, even after physical or occupational therapy, bracing, modifying activity, and over-the-counter medicine, you may benefit from PUT. Appropriate candidates for the procedure would typically have been experiencing pain for at least 3 months. PUT can be used to treat most areas of tendon disorders, including (but not limited to):
- Elbow: lateral epicondylosis (tennis elbow) and medical epicondylosis (golfer’s elbow)
- Shoulder: rotator cuff disorders including calcific tendinopathy, bicep tendinopathy
- Hip: gluteal tendinopathy (commonly diagnosed at hip bursitis and tendonitis)
- Knee: patellar tendinopathy (jumper’s knee)
- Foot and ankle: plantar fasciitis, Achilles’ tendinopathy
What are the risks of percutaneous ultrasonic tenotomy?
Risks specific to PUT also include tendon rupture and needle malfunction or breakage.
Serious side effects and complications are rare, but include:
- Allergic reaction
- Bleeding
- Nerve damage
- Infection
- Paralysis
What to expect
Most patients have an outpatient procedure done in a clinic. Please arrange for a licensed driver to meet you after the injection and drive you home, you may not drive following this procedure. Before your procedure, tell your doctor if you have:
- Allergies
- A bleeding disorder or are taking blood-thinning or anti-platelet medications
- A current infection being treated with antibiotics
- A history of getting lightheaded or fainting during procedures
Depending on your medical history, you may be asked to adjust or stop taking some of your medications prior to the procedure. Discontinue NSAIDs (aspirin, ibuprofen, naproxen, celecoxib, etc.) at least 7 days before your injection. If you take blood thinners, including aspirin, you will need to discuss potentially stopping this medication with your physician. Please discuss the safety of stopping any medication with your prescribing physician prior to doing so.
During the procedure, a local anesthetic is applied to your skin where he inserts the needle. Then, a very small incision is made in your skin to ensure the needle is guided straight to the affected tissue. The needle will be inserted into your damaged tendon under direct ultrasound visualization. Ultrasonic energy is emitted from the end of the needle device which removes damaged tissue and promotes healing. Musculoskeletal ultrasound imaging (a form of ultrasound where they can see your muscles and joints) is used to visualize where the needle needs to go.
After they’re finished, you won’t need stitches. Instead, your team applies a small steri-strip and clear bandage over the incision site following the procedure.
The affected area may feel quite sore after this procedure, particularly in the first 3 days. You can take acetaminophen (Tylenol) as needed to reduce pain and apply ice to the treated area for up to 20 minutes at a time.
Avoid anti-inflammatory medicine (like ibuprofen and naproxen) for 2 weeks after the procedure.
You will return to the clinic 2 weeks after your procedure so your team can check your incision and ensure you are healing well. Depending on your condition and how you’re healing, you may also be seen again 6–8 weeks after the procedure. You’ll be seen in clinic one last time about 3 months after your procedure is complete.
Rehabilitation timeline after percutaneous ultrasonic tenotomy
- 0–2 weeks: You may do limited activity and weight bearing exercises with boot or crutches. Your goal is to start working on regaining range of motion in the treated body part. Limit lifting to less than 2 pounds.
- 2–6 weeks: Slowly progress rehab lifting less than 5 pounds. Depending on your condition, you start formalized physical therapy around 2 weeks after the procedure.
- 6–12 weeks: Continue resistance exercise and daily activities as you’re able.
- 12 weeks: After 12 weeks, you can resume normal activities, unless your care team tells you otherwise.
Please note that your recovery time can vary. Depending on the severity of your condition and the area treated, you may start to notice reduced pain as soon as 2 weeks. Other times it can take up to 3 months to start to experience the beginnings of improvement. Your provider will advise you on your rehabilitation progression.
