Tenex TX1 is a minor surgical procedure known as Percutaneous Ultrasonic Tenotomy (or Percutaneous Ultrasonic Fasciotomy in the case of plantar fasciitis). Tenex TX1 was developed in conjunction with the world renowned Mayo Clinic and is a new form of minimally invasive surgical treatment for chronic tendon pain, such as achilles tendinopathy and tennis elbow. It is also starting to be used for chronic plantar fasciitis. The Tenex machine is an ultrasonic microcutter, designed to remove scar tissue, which is performed under ultrasound guidance so that the surgeon minimises the risk of injury to the healthy soft tissue. At the same time, a built-in inflow-outflow fluid system simultaneously irrigates and sucks up the broken down, or emulsified, tissue. Once all of the degenerated tissue is cleared away, the probe is removed, and the incision is closed with adhesive skin tape and a pressure bandage. The whole procedure takes only a few minutes, and complications are apparently few.
Here is a video demonstration of the Tenex procedure for a patient with tennis elbow provided by the manufacturers of the technology.
Evidence
To date, there is just one study on the Tenex procedure for treating plantar fasciitis, which was a case series of 12 patients (Patel 2015). The patients were reviewed 2 years after the procedure and all were pain free. None were restricted in their activity levels or needed to continue taking pain medication. All indicated they were satisfied with the procedure and would have it again. In addition to the reported success in pain relief, the procedure was also deemed safe, with no post-op complications reported. It is noted however, that author of this study is a member of the medical advisory board of Tenex Health, which developed the tissue removal system used in this study.
Risks
Although the study above did not report any post-op complications, there are concerns over the safety of this procedure, as reported by Sachez at colleagues (2017). The team published a reflective paper on 6 individual cases, where patients had undergone the Tenex procedure by other providers for Achilles tendinopathy. 3 out the 6 cases demonstrated longitudinal tears of the achilles tendon following the Tenex procedure, one patient suffered a DVT (deep vein blood clot in the calf), one patient suffered excessive swelling of the achilles tendon and one patient suffered a searing pain with a "pop" sensation 6 weeks after the procedure (Sanchez et al 2017). The authors of this case series express their concerns over the safety of Tenex for achilles tendons. Below is quote from their published paper.
"Tenex combines ultrasound visualization with a small cutting handpiece to allow for debridement of diseased Achilles tendon tissue. In theory, the surgeon would be able to visualize the pathologic portion of the Achilles tendon. In reality, ultrasound scanning delivers a 2-dimensional image of a 3-dimensional structure. This leaves surgeons with 1 of 2 scenarios: removing too much healthy tendon or failing to remove all the pathologic tendon. Also, the pistoning motion of the cutting handpiece can penetrate healthy tendon owing to the inadequate visualization provided by the ultrasound probe."
Final Thoughts
The principles of the Tenex procedure make sense as the aim of the treatment is to remove/breakdown degenerative tissue in a minimally invasive manner. This is a similar aim to other treatments such as shockwave therapy. Tenex is just a notch or two higher on the invasive scale. As Tenex is a newer treatment for plantar fasciitis owing to its recent development, there is lack of evidence available to test how safe and effective this procedure is for plantar fasciitis. Currently this treatment is only available in the USA.
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