title: Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Sustainability and Sonographic Progression at 3 Years.
abstract: BACKGROUND
  A previously published study found positive outcomes for a novel technique for ultrasound-guided percutaneous ultrasonic tenotomy, showing good tolerability, safety, and early efficacy within an office setting.
  
  
  OBJECTIVE
  In this follow-up study, all 20 members of the original cohort were contacted after 3 years to explore the sustainability of symptomatic relief, functional improvement, and sonographic soft tissue response for percutaneous ultrasonic tenotomy.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  All 20 subjects of the clinical trial that was performed from June to November 2011 were further assessed at 36 months after the procedure in terms of visual analog scale for pain, Disabilities of the Arm, Shoulder and Hand (DASH)-Compulsory/Work scores, need for adjunct procedures, and overall satisfaction. Importantly, all 20 were reassessed with ultrasound imaging at 36 months, and evidence of the common extensor tendon response was assessed in terms of tendon hypervascularity, tendon thickness, and the progress of the hypoechoic scar tissue.
  
  
  RESULTS
  A 100% clinical follow-up was achieved, inclusive of ultrasonographic assessment. None of the subjects required further treatment procedures, and 100% expressed satisfaction. Previous improvements in visual analog scale (current median ± SD, 0 ± 0.9; range, 0-3) and DASH-Work scores (current median, 0 ± 0) were sustained with conformity to a linear pattern on polynomial measures. There was further reduction in DASH-Compulsory scores to a median of 0 ± 0.644 (range, 0-2) with a significant decrease on repeated measures (P = .008). Tendon hypervascularity was resolved in 94% of patients, and 100% had reduction in tendon thickness. Overall reduction in the hypoechoic scar tissue was observed in all subjects, with a 90% response achieved by 6 months. Between 6 and 36 months, further reduction in the scar was observed in around 60% of patients, with 20% of patients having complete resolution of the hypoechoic scar.
  
  
  CONCLUSIONS
  Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. It is one of the few procedures to demonstrate positive sonographic evidence of tissue-healing response and is an attractive alternative to surgical intervention for definitive treatment of recalcitrant elbow tendinopathy.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore chusheng.seng@mohh.com.sg dr12396z@gmail.com.
authors.forename: Chusheng
authors.initials: C
authors.lastname: Seng
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: P Chandra
authors.initials: PC
authors.lastname: Mohan
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Suang Bee Joyce
authors.initials: SB
authors.lastname: Koh
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Tet Sen
authors.initials: TS
authors.lastname: Howe
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Yee Gen
authors.initials: YG
authors.lastname: Lim
authors.affiliation: Orthopaedic Associates Mount Elizabeth Hospital, Singapore.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Morrey
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000601:surgery; D010147:Pain Measurement; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D013710:Tendons / Q000601:surgery; D013716:Tennis Elbow / Q000000981:diagnostic imaging / Q000601:surgery; D058971:Tenotomy / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
keywords: minimally invasive; recalcitrant tendinopathy; ultrasonic tenotomy; ultrasound guided