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Aim of the study: There is no consensus on the most suitable non-surgical treatment of chronic lateral elbow tendinopathy. The aim of this pilot randomized controlled trial was to evaluate the size of effect of ultrasound-guided percutaneous needle tenotomy. Material and methods: Three intervention arms were formed: 1) percutaneous needle tenotomy, hydrodissection, and physiotherapy; 2) hydrodissection and physiotherapy; and 3) physiotherapy alone. Patients with chronic lateral elbow tendinopathy were randomized. Clinical endpoints included multiple questionnaires after three months: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Numeric Rating Scale (NRS) pain at rest and during activity, and EuroQol 5D-5L (EQ-5D-5L). Results: Thirty patients were included of 128 screened. The QuickDASH score improved in the percutaneous needle tenotomy and physiotherapy group, but not in the hydrodissection group. The NRS pain at rest and during activity improved more in the percutaneous needle tenotomy (resp. -2 and -2) and hydrodissection (resp. -3 and -3) groups than in the physiotherapy (resp. +1 and -1) group. The EQ-5D-5L improved similarly in all groups. Conclusions: Patients receiving percutaneous needle tenotomy and/or hydrodissection may show better results in terms of pain but not in their functional outcomes compared to those who received physiotherapy alone. The size of effect, however, is small, so a large sample size is needed for a future randomized controlled trial to further investigate these results. [ABSTRACT FROM AUTHOR]

Introduction: Congenital talipes equinovarus (CTEV) is one of the most common deformities that affects the human foot and ankle, and Ponseti method of correction is universally accepted procedure. Most of the patients need a percutaneous tenotomy of tendo Achilles for residual equinus deformity. Various methods of tenotomy such as cataract knife, No. 11 blade, and 21-G needle are available. We studied the effectiveness of percutaneous needle tenotomy of the Achilles tendon in CTEV children for residual equinus deformity. Materials and Methods: Forty-three patients of serially manipulated and casted CTEV patients were subjected to a percutaneous needle tenotomy at our institute, followed by cast and orthosis. Tenotomy and regeneration were confirmed ultrasonologically and complete tenotomy was demonstrated by animal cadaver study. Results: All the patients were followed up regularly and an average of 25° of passive dorsiflexion was achieved at an average of 2-year follow-up. No cases of skin scarring, neurovascular compromise, stiffness, or cast complications were noted in our series. Conclusion: We conclude that percutaneous needle tenotomy for residual equinus deformity in a serially casted CTEV patient is a simple, effective, and safe method in giving a functionally and cosmetically good plantigrade foot.

Congenital talipes equinovarus (CTEV) is one of the most common deformities that affects the human foot and ankle, and Ponseti method of correction is universally accepted procedure. Most of the patients need a percutaneous tenotomy of tendo Achilles for residual equinus deformity. Various methods of tenotomy such as cataract knife, No. 11 blade, and 21-G needle are available. We studied the effectiveness of percutaneous needle tenotomy of the Achilles tendon in CTEV children for residual equinus deformity. Materials and Methods: Forty-three patients of serially manipulated and casted CTEV patients were subjected to a percutaneous needle tenotomy at our institute, followed by cast and orthosis. Tenotomy and regeneration were confirmed ultrasonologically and complete tenotomy was demonstrated by animal cadaver study. Results: All the patients were followed up regularly and an average of 25° of passive dorsiflexion was achieved at an average of 2-year follow-up. No cases of skin scarring, neurovascular compromise, stiffness, or cast complications were noted in our series. Conclusion: We conclude that percutaneous needle tenotomy for residual equinus deformity in a serially casted CTEV patient is a simple, effective, and safe method in giving a functionally and cosmetically good plantigrade foot. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical response to augmenting ultrasound-guided tenotomy (USGT) with an amniotic membrane (AM) allograft injection. Design: Retrospective study. Materials & methods: Subjects underwent either a USGT (N = 16) or a combined USGT plus AM injection (N = 14). Results: Both groups demonstrated a significant reduction in pain from baseline starting after 2 weeks in the USGT plus AM group (p = 0.036) and after 8 weeks in the USGT group (p = 0.021). The reduction in pain was sustained for the entire duration of the study (52 weeks). There was no significant difference in pain levels at 26- or 52-week follow-up or patient satisfaction between the two groups. Conclusion: USGT with or without AM allograft injections results in a significant reduction in pain with high patient satisfaction. The goal of this study was to determine if a single injection of an amniotic membrane (AM) tissue improves clinical outcomes for patients with chronic tennis elbow treated with ultrasound-guided tenotomy. Ultrasound-guided tenotomy involves using a cutting device to remove degenerative tissue with ultrasound-guidance to help tendon's healing process. An AM injection is thought to reduce inflammation in the surrounding tissue, provide growth factors that help with the tendon's healing process, and minimize painful scar formation. 30 patients were included in this study (16 ultrasound-guided tenotomy [USGT] and 14 USGT plus AM injection). Both groups showed improvement in pain levels compared with their baseline at the short-term follow-up, and this reduction in pain was sustained for 52 weeks. There were no long-term differences between the two groups at the 52 week follow-up in pain levels or satisfaction. Our findings suggest that USGT, with or without AM injection, is an effective method of treatment for chronic tennis elbow. In this study, researchers found that the addition of an amniotic membrane injection does not result in quicker or greater pain relief when used to augment tennis elbow surgery with Tenex™. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate the clinical response to augmenting an ultrasound-guided percutaneous plantar fasciotomy (UGPF) with an amniotic membrane (AM) allograft injection. Design: Retrospective, single-center, matched, case-controlled study. Methods: Patients underwent either an UGPF (n = 15) or a combined UGPF and AM injection (n = 16). Results: The UGPF plus AM group demonstrated a significant reduction in pain (p = 0.02) from baseline at the short-term follow-up, but there was no significant difference in pain or patient satisfaction between groups at the 52-week follow-up. Conclusion: Both groups demonstrated a significant reduction in pain and high level of patient satisfaction, but the combination of UGPF with an AM injection may provide a greater reduction in pain earlier in the post-operative period. The purpose of this study was to determine if a single injection of an amniotic membrane (AM) tissue injection improves pain and satisfaction scores for patients with chronic plantar fasciitis treated using ultrasound guided percutaneous fasciotomy (UGPF). The UGPF procedure involves using ultrasound to guide a cutting device into the plantar fascia to cut and remove degenerative tissue. 31 patients were included in the study (15 UGPF and 16 UGPF plus AM). Both groups demonstrated improvement in pain at the 16 and 52-week follow-up visits. There was a greater improvement in pain in patients treated with the UGPF and AM injection in the short term (at 16-week follow-up). There was no long-term difference between the two groups at the 52-week follow-up. Both groups demonstrated a high level of patient satisfaction. Findings suggest that combination of UGPF with AM tissue injection may improve symptoms of chronic plantar fasciitis sooner than if a patient only underwent an UGPF procedure alone. The AM allograft does not seem to change the long-term outcome. Larger studies are warranted. In a preliminary study, researchers found that amniotic membrane injections may provide faster pain relief when injected into the plantar fasciotomy during surgery. [ABSTRACT FROM AUTHOR]

Introduction Core muscle injuries (CMI) are common in every sport. To minimize lost playing time, providers apply various nonsurgical treatments, including platelet-rich plasma, corticosteroids, ultrasound (US)-guided percutaneous tenotomy, and prolotherapy. Limited data exist with regard to their effectiveness. We chose to review a cohort of consecutive professional and collegiate athletes who sustained CMI at various points within their seasons and underwent a combination of US-guided percutaneous needle "tenotomy" and corticosteroid injections to complete the remainder of their seasons. Methods Twenty-five consecutive collegiate or professional athletes with CMI involving the rectus abdominis–adductor aponeurotic plate were included in this retrospective study. Athletes with concomitant symptomatic hip femoroacetabular impingement were included in the study. The primary outcome measure was whether athletes completed their seasons. Secondary measures were weeks played after the procedures (delay until surgery), need for repeat procedures, and outcomes after eventual surgery. Postoperative performance was assessed via interviews at 6 wk and 6 months postoperatively. Results Twenty-one of 25 (84%) athletes completed their seasons. On average, athletes returned to play 3 d (range, 1–9 d) after the procedures. Surgical repair was delayed a mean of 18 wk (range, 2–44 wk). Seven athletes had concomitant symptomatic femoroacetabular impingement and six underwent combined hip arthroscopy and core muscle repairs. Among 17 patients who eventually had core muscle surgery alone (no hip surgery), 82% (14 of 17) reported performing at their preinjury level at 6 wk. At 6 months, 96% of postop athletes (22 of 23) reported performing at their preinjury level. Conclusions Temporizing CMI with US-guided percutaneous tenotomy and corticosteroid injections is effective in allowing continued sport participation among high-level athletes and does not negatively affect postoperative outcomes. [ABSTRACT FROM AUTHOR]

Percutaneous needle tenotomies constitute a promising approach that enables direct access to tendons through minimally invasive interventions. They can be performed rapidly without need for large incisions or general anaesthesia. However, the reported procedures are heterogeneous and currently conducted without guidelines. We aimed to determine the indications for percutaneous needle tenotomies described in the current literature. Our secondary aim was to identify the different procedures reported, as well as their efficacy and their safety. A systematic review following PRISMA guidelines was conducted to identify original articles that mentioned percutaneous needle tenotomy in humans and reported its application, description, effectiveness or adverse events. Non-percutaneous tendinous surgical procedures and ineligible designs were excluded. The Downs and Black checklist was used to assess the risk of bias. A total of 540 studies were identified from the MEDLINE, Embase, Cochrane Library, and PEDro databases. Fourteen clinical studies met the inclusion criteria and were found to have an acceptable quality (674 individuals, 1664 tenotomies). Our results indicated a wide variety of indications for percutaneous needle tenotomies in children and in adults. We highlighted 24 tendons as eligible targets in the upper and lower limbs. Tenotomies were performed with either 16- or 18-Ga needles, lasted from 1 to 30 min, and were performed using various procedures. Their efficacy was mainly assessed through clinical outcomes highlighting tendon discontinuity on palpation after the procedure. Passive range-of-motion gains after tenotomy were reported for both upper and lower limbs with an estimated 5 % complication rate. This is the first review to systematically synthesize all the available evidence on the indications, procedures, efficacy and safety of percutaneous tenotomies exclusively performed with needles. Current evidence suggests that procedures are safe and effective for treating various deformities. CRD42022350571 [ABSTRACT FROM AUTHOR]

The article describes the case of a 45-year-old male who presented with right lower abdominal, pelvic and worsening groin pain that started after completing a 22-mile run a year ago. Topics covered include the medical history of the patient, the findings of the pelvic magnetic resonance imaging (PMI) which led to a diagnosis of a core muscle injury due to right partial adductor longus origin tear and tendinopathy, and patient outcome after ultrasound-guided percutaneous needle tenotomy (PNT).

Knee flexion contracture is observed sometimes in the elderly walking. The serial cast method has been successful in treating knee contracture secondary to neurological diseases after injection of botulinum toxin. We focus on 3 cases: all patients were unable to walk because of knee flexion contracture. They have benefited from our protocol of serial casts and at the end of the treatment, knee flessum was less. All patients have recovered the ability to walk. Our method is simple and fast. For these 3 patients, we could discuss percutaneous needle tenotomies but it requires a trained team. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of percutaneous needle tenotomy during ponseti technique in the management of congenital club foot deformity in children. Study design: Descriptive case series. Place and duration of study: Orthopaedic unit, Lady Reading Hospital, Peshawar17th August 2018 to 17th February 2019. Material and Methods: In this study a total of 139 patients were observed. All children were operated with aseptic precautions under short general anaesthesia. A 16/18 gauge needle chosen to cut the tendon, Thereafter, patients was followed up on a monthly basis and efficacy was evaluated aft er six months. Results: In this study mean age was 12 months with SD ± 7.31. 57% patients were male while 43% patients were female. 40% patients had bilateral foot while 60% patients had unilateral foot. More over percutaneous needle tenotomy was effective in 92% patients and was not effective in 8% patients. Conclusion: Our study concludes that percutaneous needle tenotomy is 92% effective during ponseti technique in the management of congenital club foot deformity in children. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcome of percutaneous needle tenotomy in the treatment of resistant lateral epicondylitis Study design: Descriptive study Place and duration of study: Outpatient Department (OPD) of Orthopedics and TraumaQazi Hussain Ahmad Medical Complex Nowshera and Private clinics in Kohat, KPK, Pakistan from January 2016 to December 2017. Materials and Methods: 20 patients with resistant lateral epicondylitis meeting the inclusion criteria were enrolled in the study. Each patient underwent percutaneous needle tenotomy of the common extensor tendon with 18G hypodermic needle under local anesthesia. Pre-procedure and post-procedure assessment at 12 weeks was doneusing VAS pain score and Nirschl stage. Results: Out of 20 patients, 16(80%) patients were females and 4(20%) were males. Average age of the patients was 40.75years±8.03SD. In 17(85%) patients, right elbow was involved while in 3(15%) patients, leftelbow was involved. Most of the patients (15, 75%) were in the age range of 30-50 years. Mean duration of symptoms was 31.85weeks±4.88SD. At 12 weeks, mean VAS pain score decreased from 8.05±1.36SD to 1.35±2.22SD while mean Nirschl stage decreased from 6.15±0.85SD to 0.95±1.63SD. There was statistically significant decrease in VAS pain score and Nirschl stage at 12 weeks (p-value <0.001). Treatment was successful in 70% (14) of patients (VAS pain score ≤ 2). Temporary pain at tenotomy site was reported by 2 (10%) patients. No case of hematoma formation or infection was reported. No patient was lost to follow up. Conclusion: Percutaneous needle tenotomy for resistant lateral epicondylitis is easy, safe, effective and minimally invasive procedure which can be done at outpatient department. We recommend long-term comparative study to confirm our results. [ABSTRACT FROM AUTHOR]

Insertional peroneus brevis tendinopathy is uncommon and treatment options for recalcitrant insertional lesions are rarely described in the literature. Ultrasound-guided percutaneous ultrasonic needle tenotomy has been described for the treatment of recalcitrant tendinopathy in the elbow, knee, and plantar fascia, but has not been described for the treatment of peroneal tendinopathy. We report a case of recalcitrant insertional peroneus brevis tendinopathy successfully treated with an ultrasound-guided percutaneous ultrasonic needle tenotomy. The treatment resulted in a rapid recovery, and the patient remained asymptomatic at the 6-month follow up. No complications were observed during follow up and the minimally invasive percutaneous procedures offers clear advantage over open techniques., (Copyright © 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective The musculotendinous retractions are common complications of central neurological damage with consequences for comfort and function. Treatment of uncomfortable retractions is often surgical, mainly based on tendon gestures. The objective of this study was to evaluate the efficiency of percutaneous needle tenotomy in these indications. Material/patients and methods The indication was accepted at a medical-surgical consultation. Tenotomy was performed using an 18 Gauge needle. The patients were older than 18 years, had a history of central neurological disease, and had a musculotendinous retraction regarding a superficial tendon of upper limb. The primary endpoint was the Goal Attainment Scale (GAS). Secondary outcomes were pain, the pulp-palm distance and range of motion gain. The evaluation was conducted in pre-tenotomy, immediately post-tenotomy, 3 months and 6 months. Results Twelve patients (8 women) were included in our study. The mean age was 62.91 years (28–87). Neuro-orthopedic disorders were related to a stroke ( n = 4), head trauma ( n = 2), to Parkinsonian syndrome ( n = 3) at a cerebral palsy ( n = 3). The objectives identified were nursing ( n = 12), pain ( n = 11), the skin condition ( n = 5), gripping ( n = 2), posture ( n = 1) and dressing ( n = 1). The targets were achieved in all cases. The average score GAS per patient ranged from 0 to 2. GAS score was unchanged at 3 months and 6 months. Discussion–conclusion Our experience confirms the locations already described for percutaneous needle tenotomy of the flexor of the fingers. We also report the effectiveness of percutaneous tenotomy in the wrist and elbow flexors without vascular and nerve injury elbow. [ABSTRACT FROM AUTHOR]

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance., Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE., Study Design: Cohort study; Level of evidence, 3., Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction., Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P < .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P < .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group ( P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course., Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Trauma and the mechanical strain of high-energy activity predispose athletes to pelvic injuries. Magnetic resonance imaging remains the primary modality for diagnosing these conditions, but ultrasonography-guided interventions are important in the management of core muscle, hip, and other pelvic conditions. This article reviews ultrasonography-guided interventions for injuries at the core, including the pelvis and hips. It reviews common injuries, procedure optimization, medication preparation, clinical evidence behind injections, tenotomy, and platelet-rich plasma. These interventions are especially important in athletes, because ultrasonography-guided procedures are often undertaken early in the treatment process, paralleling conservative rehabilitation to facilitate a faster return to play., (Copyright © 2016 Elsevier Inc. All rights reserved.)