Percutaneous Ultrasonic Tenotomy-- Indications, Pitfalls and Best Practices-Session Recording

Video Transcription

Video Summary

The presentation thoroughly examined the technique and application of Percutaneous Ultrasonic Tenotomy (PUT), alternatively known as the Tenex procedure. Hosted by Brian Lim, a Clinical Associate Professor at the University of Washington, it featured contributions from experts including Dr. Stephanie Peralt and Dr. Eric Latska. The session focused on treatment protocols, procedural mechanics, and best practices for managing chronic tendinopathies, emphasizing the progression from tendinitis to tendinosis—a non-inflammatory degenerative condition. Dr. Peralt explored patient selection criteria, suggesting PUT for patients with over three months of symptoms, resistant to standard treatments. Imaging via ultrasound or MRI is crucial to confirm tendinosis. Regarding the procedure, aspects such as neurovascular safety, depth targeting, and ergonomic positioning are imperative for successful intervention. Notably, anesthesia often involves a mix of lidocaine and ropivacaine, with consideration for nerve blocks in specific cases. Dr. Latska also highlighted the importance of long-axis approaches to minimize healthy tissue disruption.<br /><br />Participants in the session debated short versus long-axis approaches based on earlier research and personal familiarity with the procedure. Additionally, Dr. Kenyon emphasized individualized post-procedure rehabilitation, recommending exercise regimens to be adjusted according to patient response. Recovery phases typically include reduced initial activity followed by gradual reintroduction of strength and functional dynamics over several weeks.<br /><br />While some discussions compared PUT to Platelet-Rich Plasma (PRP) treatments, the consensus highlighted PUT as a viable, minimally invasive option particularly effective after conventional therapies fail, with procedural benefits like minimal recovery time. Insurers in the U.S. cover PUT well, making it a cost-effective alternative to PRP, despite its generally better outcomes. Though the procedure shows promise, contradictions exist concerning its efficacy in large tear repairs and different anatomical applications, emphasizing the need for further research. Overall, the event underscored PUT’s potential in managing chronic tendinopathies safely and effectively with adequate pre-and post-treatment guidelines.

Keywords

Percutaneous Ultrasonic Tenotomy

Tenex procedure

chronic tendinopathies

tendinitis

tendinosis

ultrasound imaging

neurovascular safety

anesthesia

rehabilitation

Platelet-Rich Plasma

minimally invasive

treatment protocols