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Percutaneous ultrasound-guided needle tenotomy for treatment of chronic tendinopathy and fasciopathy: a meta-analysis

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 01 July 2024

A Publisher Correction to this article was published on 20 June 2023

This article has been updated

Abstract

Objectives

To systematically assess the efficacy of percutaneous ultrasound-guided needle tenotomy (PUNT) in the treatment of chronic tendinopathy and fasciopathy.

Methods

A comprehensive literature search was performed with the following search terms: tendinopathy, tenotomy, needling, Tenex, fasciotomy, ultrasound-guided, and percutaneous. Inclusion criteria consisted of original studies evaluating pain or function improvement after PUNT. Meta-analyses investigating standard mean differences were performed to assess the pain and function improvement.

Results

Thirty-five studies with 1674 participants (1876 tendons) were enrolled in this article. Of which 29 articles were included in meta-analysis and the remaining 9 articles without enough numeric data were included in descriptive analysis. PUNT significantly alleviated pain with the standard mean difference of 2.5 (95% CI: 2.0–3.0; p < 0.05), 2.2 (95% confidence interval (CI): 1.8–2.7; p < 0.05), and 3.6 (95% CI: 2.8–4.5; p < 0.05) points in short-term, intermediate-term, and long-term follow-up intervals, respectively. It was also associated with marked improvement in function with 1.4 (95% CI: 1.1–1.8; p < 0.05), 1.8 (95% CI: 1.3–2.2; p < 0.05), and 2.1 (95% CI: 1.6–2.6; p < 0.05) points, respectively in short-term, intermediate-term, and long-term follow-ups.

Conclusion

PUNT improved pain and function at short-term intervals with persistent results on intermediate- and long-term follow-ups. PUNT can be considered an appropriate minimally invasive treatment for chronic tendinopathy with a low rate of complications and failures.

Clinical relevance

Tendinopathy and fasciopathy are two common musculoskeletal complaints that can cause prolonged pain and disability. PUNT as a treatment option could improve pain intensity and function.

Key Points

• The best improvement in pain and function was achieved after the first 3 months following PUNT and was continued to the intermediate- and long-term follow-ups.

• No significant difference was found between different tenotomy methods in terms of pain and function improvement.

• PUNT is a minimally invasive procedure with promising results and low complication rates for treatments of chronic tendinopathy.

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Change history

Abbreviations

MCID:

Minimal clinically important difference

PRP:

Plasma-rich platelet

PUNT:

Percutaneous ultrasound guided tenotomy

SI:

Steroid injection

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Acknowledgements

The authors thank Amirhossein Ramezani Ahmadi, PhD, for assistance in the statistical analysis.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬

Funding

The authors state this work has not received any funding.

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Authors and Affiliations

  1. Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA

    Firoozeh Shomal Zadeh, Mehrzad Shafiei, Mostafa Shomalzadeh, Peter Christian Thurlow & Majid Chalian

  2. Musculoskeletal Imaging and Intervention, Department of Radiology, University of Virginia, Charlottesville, VA, USA

    Jennifer Pierce

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  1. Firoozeh Shomal Zadeh
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Correspondence to Majid Chalian.

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The scientific guarantor of this publication is Dr. Majid Chalian.

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Majid Chalian

- RSNA R&E Research Scholar Grant

- Boeing Technology Development Grant

The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Amirhossein Ramezani Ahmadi kindly provided statistical advice for this manuscript.

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This study is a systematic review and meta-analysis so exempt from informed consent.

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This study is a systematic review and meta-analysis so exempt from ethical approval.

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Nothing of the study subjects or cohorts of this study have been previously published (except an abstract which is presented in RSNA 2021).

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Shomal Zadeh, F., Shafiei, M., Shomalzadeh, M. et al. Percutaneous ultrasound-guided needle tenotomy for treatment of chronic tendinopathy and fasciopathy: a meta-analysis. Eur Radiol 33, 7303–7320 (2023). https://doi.org/10.1007/s00330-023-09657-2

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