title: Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: early clinical experience with a novel device for minimally invasive percutaneous microresection.
abstract: BACKGROUND
  The optimal choice for intervention for recalcitrant lateral elbow tendinopathy remains unclear as various treatment modalities have documented comparable results in the literature.
  
  
  OBJECTIVE
  To explore the safety, tolerability, and early efficacy of a new minimally invasive mode of treatment that delivers focused, calibrated ultrasonic energy, effectively microresecting the pathological tendon and removing only pathological tissue.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Seven male and 13 female patients aged 33 to 65 years averaging 12.5 months (range, 4-48) of failed nonoperative therapy underwent the ultrasonic microresection procedure in an outpatient clinic setting. The procedure involved a sterile, ultrasound-guided percutaneous microresection with a proprietary device (TX1) performed through a stab incision under local anesthesia. The duration of the procedure and complications of the device or procedure were assessed. Outcome parameters included patient satisfaction; visual analog scale (VAS) pain scores; Disabilities of the Arm, Shoulder and Hand (DASH) scores at 1, 3, 6, and 12 months; and ultrasound assessment at 3 and 6 months.
  
  
  RESULTS
  The median duration for the sterile confirmatory ultrasound examination (phase 1) was 88.5 seconds (range, 39-211; SD, ±47.6), the median duration of the procedure proper (phase 2) was 10.1 minutes (range, 4.1-19.4; SD, ±3.7), and the median energy time (duration the TX1 device was activated) was 32.5 seconds (range, 18-58; SD, ±11.0). No complications were encountered. A significant improvement in VAS score (from 5.5 to 3.3; P < .001) occurred by 1 week, and significant improvements in both DASH-Compulsory (from 21.7 to 11.3; P = .001) and DASH-Work (from 25.0 to 6.3; P = .012) scores occurred by 1 month. The VAS scores further improved at 3, 6, and 12 months (from 2.0 to 1.0 to 0.50; P = .003 and .023). The DASH-Compulsory score improved significantly from 3 to 6 months (from 8.6 to 4.6; P = .003), and both the DASH-Compulsory and DASH-Work scores were sustained by 12 months. Sonographically reduced tendon thickness (19 patients), resolved or reduced hypervascularity (17 patients), and reduced hypoechoic area (18 patients) occurred by 6 months. Nineteen of the 20 patients (95%) expressed satisfaction with the procedure, with 9 patients being very satisfied with their overall experience at 6 months after the procedure, 10 patients somewhat satisfied, and 1 patient neutral.
  
  
  CONCLUSIONS
  Ultrasonic microresection of diseased tissue with the TX1 device provides a focally directed, safe, specific, minimally invasive, and well-tolerated treatment for recalcitrant lateral elbow tendinopathy in an office-based or ambulatory surgical setting with good evidence of some level of efficacy in 19 of 20 patients (95%) that is sustained for at least 1 year.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608. jk061071@singnet.com.sg
authors.forename: Joyce S B
authors.initials: JS
authors.lastname: Koh
authors.forename: P C
authors.initials: PC
authors.lastname: Mohan
authors.forename: T S
authors.initials: TS
authors.lastname: Howe
authors.forename: Brian P
authors.initials: BP
authors.lastname: Lee
authors.forename: S L
authors.initials: SL
authors.lastname: Chia
authors.forename: Zixian
authors.initials: Z
authors.lastname: Yang
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Morrey
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D004185:Disability Evaluation; D004550:Elbow / Q000000981:diagnostic imaging / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D052256:Tendinopathy / Q000601:surgery*; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery*; D058971:Tenotomy / Q000295:instrumentation / Q000379:methods*; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*; D018084:Ultrasonography, Interventional