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What is the reason for tenotomy?

Published in Tendon Healing 4 mins read

Tenotomy is performed primarily to stimulate the body's natural healing processes, accelerating recovery from persistent injuries or debilitating conditions, particularly those affecting tendons.

What is Tenotomy?

Tenotomy is a minimally invasive medical procedure that involves making a small incision or precisely controlled micro-trauma to a tendon. Tendons are the strong, fibrous cords of connective tissue that attach muscles to bones, playing a crucial role in movement. The procedure is typically performed to address chronic tendon pain and dysfunction that have not responded to conservative treatments like physical therapy, rest, or medication.

Why is Tenotomy Performed?

The main reason for performing a tenotomy is to jump-start the body's inherent healing mechanism when a tendon has suffered chronic damage or degeneration. Unlike acute injuries, chronic tendon conditions (often called tendinopathy) involve a failure of the tendon to heal properly, leading to persistent pain and impaired function. By creating a controlled, targeted injury to the affected area of the tendon, tenotomy aims to convert a chronic, non-healing state into an acute injury response, thereby initiating a new cycle of repair and regeneration. This process is designed to speed healing and recovery from an injury or debilitating condition.

Here are the key reasons tenotomy is performed:

Reason Explanation
Stimulate Healing To initiate the body's natural repair processes in a chronically damaged tendon that has stopped healing.
Accelerate Recovery To speed up the resolution of pain and functional limitations associated with tendon injuries or conditions, leading to faster return to activity.
Address Chronic Tendinopathy For conditions where tendons have undergone degenerative changes and conventional treatments have failed.
Improve Function and Reduce Pain By promoting healing, tenotomy aims to restore the structural integrity of the tendon, reduce inflammation, and alleviate chronic pain, ultimately improving overall joint or limb function.
Minimally Invasive Alternative Often chosen as a less invasive option compared to traditional open surgery for certain tendon issues.

How Does Tenotomy Work?

The mechanism behind tenotomy is rooted in the body's natural response to injury:

  1. Controlled Micro-Trauma: A tiny cut or series of small punctures are made in the diseased or damaged part of the tendon. This is often performed using a needle, precisely guided to the target area.
  2. Inflammatory Response: This controlled injury triggers an acute inflammatory cascade. The body perceives this as a new injury, sending a rush of blood, growth factors, and specialized cells (like fibroblasts) to the site.
  3. Cellular Regeneration: These healing cells begin to remove damaged tissue and lay down new collagen fibers, which are the building blocks of healthy tendons.
  4. Remodeling: Over time, these new collagen fibers mature and align, strengthening the tendon and restoring its structure and function.

This process essentially "resets" the healing cycle, converting a stalled, chronic condition into an active healing phase.

Benefits of Tenotomy

Patients undergoing tenotomy can experience several benefits:

  • Pain Reduction: Alleviates chronic pain associated with tendinopathy.
  • Improved Function: Restores range of motion and strength in the affected area.
  • Faster Recovery: Accelerates the overall healing process compared to prolonged conservative management.
  • Minimally Invasive: Often performed using a needle, leading to smaller incisions, less scarring, and quicker recovery times than open surgery.
  • Targeted Treatment: Allows for very precise treatment of the specific damaged area within the tendon.

Common Applications

Tenotomy is utilized for various chronic tendon conditions that have not responded to other forms of treatment. Some common applications include:

  • Achilles Tendinopathy: Pain and stiffness in the Achilles tendon, often seen in runners.
  • Patellar Tendinopathy (Jumper's Knee): Pain below the kneecap, common in athletes involving jumping.
  • Tennis Elbow (Lateral Epicondylitis): Pain on the outside of the elbow, affecting forearm extensor tendons.
  • Golfer's Elbow (Medial Epicondylitis): Pain on the inside of the elbow, affecting forearm flexor tendons.
  • Rotator Cuff Tendinopathy: Pain and weakness in the shoulder due to inflammation or degeneration of rotator cuff tendons.
  • Plantar Fasciitis: Although technically a fascial issue, chronic cases sometimes benefit from similar needle-based procedures to stimulate healing in the plantar fascia.

Procedure Details

Tenotomy procedures are often performed with a high degree of precision. Subspecialized musculoskeletal imaging physicians frequently use advanced imaging techniques, such as ultrasound guidance, to accurately direct a needle to the exact location of the damaged tendon. This allows for meticulous targeting of the affected tissue while minimizing impact on surrounding healthy structures, enhancing both the safety and effectiveness of the procedure.

For more information on tendon health and related treatments, you can explore resources from reputable medical institutions like the American Academy of Orthopaedic Surgeons.