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Minimally Invasive Ultrasonic Tenotomy for Medial and Lateral Epicondylosis Allows for Early Recovery and Return to Work
Elizabeth Elander, PA-C; Anna Cobb, MS, DC; Tyson Cobb, MD
Orthopaedic Specialists, Inc, Davenport, IA

Introduction: The Tenex Health TX-1 (TX-1) device delivers ultrasonic energy to remove abnormal tendon in patients with tendonosis. TX-1 has been observed to result in early return to activity in some patients. Although mean pain results with 1-year follow-up are well established, detailed return to activity is lacking. The purpose of this study was to report the early results of treatment of medial and lateral epicondylosis with TX-1 in order to define early return to activity.

Materials & Methods: IRB approval and signed consents were obtained. Patients undergoing TX-1 treatment for tendonosis were prospectively enrolled. Surgery duration and incision length were recorded. Preoperative, intraoperative, and postoperative data (1, 2, 3, 6, and 12 weeks) were collected. Variables obtained include Patient Rated Tennis Elbow Evaluation (PRTEE) score, overall pain (0-10), grip strength, patient reported return to normal activity and full-duty work, and satisfaction (range 1-5; 5=very satisfied). Patients kept a daily pain diary for the first 14 days postoperatively.

Results: Forty-two patients underwent 48 TX-1 treatment procedures including 7 medial, 29 lateral, and 6 simultaneous medial and lateral. There were 18 females and 24 males with a mean age of 48 (range 32-66). The mean duration of preoperative symptoms was 12 months (range 3-42). Mean total duration of surgery was 12 minutes (range 5-33). Average size of incision was 5 mm (range 3-11). Preoperative and 12 week mean PRTEE scores were 47 and 17 respectively. Preoperative and 12-week mean grip scores were 17 kg and 24 kg respectively. Twenty-five percent of patients were back to normal activity within 9 days following surgery, 50% by 29 days, and 75% by 59 days. Twenty-five percent of patients returned to full-duty work by 8 days postoperatively, 50% by 27 days, and 75% by 70 days. Mean pain scores preoperatively and at each postoperative visit were 5.7, 3.6, 3.5, 3.2, 2.5, and 2.1 respectively. Mean satisfaction at 12-weeks was 4. There were no intraoperative or postoperative complications.

Conclusions: These data provide some guidance when discussing expectations of early postoperative recovery with patients. Twenty-five percent of patients return to normal activity by 2 weeks, and 50% by 1 month. Although biologic studies of tendon healing suggest a tendon should be protected for 6 to 12 weeks postoperatively, our data suggest that removing only the diseased tendon using TX-1, which leaves the normal tendon intact, allows for early return to activity without compromising healing. Follow-up is ongoing.

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