What is Microtenotomy (Tendon microsurgery)?
Microtenotomy is a minimally invasive tendon surgery used primarily for treating chronic tendinopathies (like lateral epicondylitis, Achilles tendinosis, or rotator cuff tendinosis) that have not responded to conservative treatments. The procedure involves making microscopic incisions in the tendon tissue to stimulate healing and restore function.
Two major types of microtenotomy techniques are currently in use:
- Radiofrequency microtenotomy
- Needle-based microtenotomy.
Indications for Microtenotomy
Microtenotomy is commonly indicated in the following conditions:
- Chronic tendinopathy (tennis elbow, golfer’s elbow)
- Achilles tendinosis
- Plantar fasciitis
- Rotator cuff tendinosis
- Patellar tendinosis (jumper’s knee)
- Refractory pain and limited function despite physiotherapy and injections
How Microtenotomy Works
Tendinopathies are characterized by degeneration rather than inflammation. There is disorganized collagen, neovascularization, and nerve ingrowth contributing to pain. Microtenotomy disrupts these degenerative tissues, encourages localized bleeding, and stimulates a healing response through neovascularization and fibroblast activation.
How is Microtenotomy Performed?
Radiofrequency Microtenotomy:
- This is performed under local anesthesia.
- A specialized radiofrequency (RF) probe is inserted through a small skin incision.
- The RF energy delivers controlled ablation pulses (typically at 500 kHz) to the affected tendon.
- Each pulse creates a microchannel in the tendon, stimulating angiogenesis and cellular remodeling.
- Real-time ultrasound may guide precise targeting of degenerated tissue.
Advantages of Radiofrequency Microtenotomy
- Minimally invasive with little soft tissue disruption.
- Controlled, consistent energy delivery.
- Reduced post-operative pain.
- Quick return to activities.
Postoperative Care of Radiofrequency Microtenotomy
- Short period of immobilization.
- Progressive physical therapy initiated after a few days.
- Full recovery within 4–8 weeks in most cases.
Needle Microtenotomy (Percutaneous Needle Tenotomy)
- This is performed under local anesthesia and ultrasound guidance.
- A fine needle (usually 18G or 22G) is inserted percutaneously.
- Multiple fenestrations (or needling strokes) are made into the degenerated tendon area.
- The mechanical disruption creates microtrauma, breaking up scar tissue and
- promoting a reparative inflammatory response.
- Often combined with autologous blood or platelet-rich plasma (PRP) injections.
Advantages of Needle Microtenotomy
- Simple and cost-effective.
- Can be performed in an outpatient setting.
- No heat generation or thermal injury.
Postoperative Care of Needle Microtenotomy
- Mild soreness expected for a few days.
- Activity restriction for 1–2 weeks.
- Gradual rehabilitation with strengthening exercises.
