What Is Tenotomy?: Overview and More

A tenotomy is a surgical procedure in which a tendon is cut because it is overpowered or contracted, which can cause pain. A tenotomy can relieve chronic tendon pain and tightness when other treatment methods fail to improve symptoms of chronic irritation or damage.

This article will review what conditions can be treated with a tenotomy, how it is performed, different types of tenotomies, eligibility criteria, and treatment outcomes. 

Definition 

Tenotomy, which means “cutting into a tendon,” is a surgical procedure in which a tendon is cut. A tenotomy can involve completely cutting a tendon in two, which separates it from where it attaches to the bone. It may also involve making tiny cuts along the length of the tendon while still keeping it attached to the bone. This is called lengthening, as it increases the length of the tendon and weakens the pull of the muscle.

Types

A traditional tenotomy involves either a partial or full cut through a tendon to partially or fully detach the tendon from where it attaches to the bone. To access the tendon, a surgical incision is made through the skin, and the tendon is isolated from surrounding structures to make a clean cut through the width of the tendon.

Another type of tenotomy is called an ultrasound-guided percutaneous tenotomy. With this type of procedure, an ultrasound tool is used to locate the tendon. An instrument with a needle-like attachment that emits ultrasonic waves is then applied to the skin to produce small cuts that help break down scar tissue and increase blood flow to the tendon.

Conditions Treated

A tenotomy is used as a last resort treatment option to treat chronic tendinopathies, or tendon injuries, that do not heal with conservative treatment methods including physical therapy and cortisone injections. 

A tenotomy is commonly performed to treat the following:

• Plantar fasciitis
• Tennis elbow
• Small tears of the Achilles tendon
• Small tears of the rotator cuff

Areas of the body where a percutaneous tenotomy is commonly performed include:

• Achilles tendon
• Common wrist extensor tendon
• Common wrist flexor tendon
• Supraspinatus tendon
• Subscapularis tendon
• Infraspinatus tendon
• Gluteus medius and minimus tendons
• Quadriceps and patellar tendons
• Tibialis anterior and tibialis posterior tendons
• Hamstrings tendons
• Peroneal tendons

Process

Both types of tenotomies are performed in an outpatient setting, meaning you can go home after your procedure. However, a traditional tenotomy is more invasive, while a percutaneous tenotomy is minimally invasive.

Traditional Tenotomy

A tenotomy is a surgical procedure that involves cutting into a tendon. You will be taken into an operating room, and local anesthesia will typically be applied to your skin to numb the area around the tendon. Sometimes general anesthesia will be used to put you to sleep for the operation.

Your surgeon will then cut through the skin to access the tendon and make a horizontal cut through the width of the tendon to partially or fully detach the tendon from where it attaches to the bone. The incision in your skin will then be closed with sutures (stitches).

Percutaneous Tenotomy

A percutaneous tenotomy can be performed in an examination room in your healthcare provider's office, similar to how a cortisone injection would be given. You will lie down on a treatment table, and local anesthesia will be applied to your skin to numb the area around the tendon. 

Your healthcare provider will apply an ultrasound transducer over your skin to precisely locate your tendon. An instrument with a needle-like attachment will then be used next to emit ultrasonic waves that will be delivered through your skin to make small cuts lengthwise along the tendon to remove scar tissue and promote tendon healing. A percutaneous tenotomy typically takes 15 to 20 minutes.

Who Does It

A tenotomy is usually performed by an orthopedic surgeon in an outpatient surgical setting. A podiatrist may also be able to perform a tenotomy for tendons of the foot and ankle, such as the Achilles tendon, peroneal tendons, or tibialis anterior or posterior tibialis tendons.

Uses 

Also commonly called tendon release or tendon lengthening, a traditional tenotomy is performed to release a tendon from where it attaches to the bone. Cutting a tendon releases tension from the tendon, which can help relieve chronic pain. 

A percutaneous tenotomy is used to de-bride a tendon, or remove areas of degenerated tendon fibers, and increase blood flow through small cuts in the tendon to promote healing. It is also used to lengthen the tendon to weaken the pull of the muscle.

How to Prepare

Both types of tenotomies are typically performed in the outpatient surgical setting, meaning you do not need to stay overnight in a hospital. Your healthcare provider will give you specific instructions before your procedure, which may include temporarily stopping the use of certain medications to prevent excessive bleeding during the procedure.

Eligibility

A tenotomy is used as a last resort treatment option for tendinopathies that do not improve after several months of conservative treatment methods, which include:

• Rest
• Ice
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy
• Cortisone injections
• Braces
• Durable medical equipment (DME)

Outcomes and Recovery

Both traditional and percutaneous tenotomies generally have good post-procedure outcomes. Because a percutaneous tenotomy is a minimally invasive procedure, it has been associated with reduced pain after the procedure, decreased risk of infection, and increased rate of rehabilitation with a faster return to everyday activities.

A 2021 review suggests that percutaneous tenotomy procedures yield a high satisfaction rate of greater than 70% for treating chronic tendinopathies due to decreased pain and improved function with a low complication rate of 0.7%.

Following your tenotomy, you will have specific rehabilitation instructions to follow. This generally includes an initial two-week rest period, followed by regular physical therapy to improve the strength and range of motion of the muscle associated with your tendon.

Depending on where your tenotomy was performed, restrictions following a tenotomy in the initial weeks of recovery may include:

• Partial weight bearing on your leg with the use of a protective walking boot or knee brace for one to two weeks
• Lifting restrictions of no more than 5 pounds for six weeks

Most people return to unrestricted work and exercise after 12 weeks.

Warnings

Because a tenotomy involves cutting into tendon tissue, further injury to a tendon can occur. Risks associated with a tenotomy include:

• Increased pain
• Burning at the tendon site
• Swelling 
• Muscle cramping
• Risk of infection
• Tendon rupture 

Summary

A tenotomy is a surgical procedure in which a tendon is cut to relieve chronic pain and tightness. A tenotomy can be a traditional tenotomy, where a partial or full cut is made into the tendon, or a percutaneous tenotomy, in which an instrument that uses ultrasound waves is used to make multiple minor cuts into a tendon through the skin.

A tenotomy is a last resort treatment option when conservative methods like rest, physical therapy, NSAIDs, and cortisone injections for treating chronic tendon problems fail to improve symptoms. A tenotomy has relatively good treatment outcomes, including decreased pain and improved function.

A Word From Verywell

Make sure you discuss the risks of a tenotomy procedure with your healthcare provider. While a tenotomy can improve pain and function when other treatment methods are ineffective over the long term, your healthcare provider must have experience with tenotomy procedures for the best possible outcomes. Ask your healthcare provider how frequently they perform tenotomies and what results were observed afterward.