Microtenotomy Using a Radiofrequency Probe to Treat Lateral Epicondylitis James P. Tasto, M.D., Jeffrey Cummings, M.D., Virgil Medlock, M.D., Renee Hardesty, L.V.N., and David Amiel, Ph.D. Purpose: To evaluate the safety and effectiveness of microtenotomy using a radiofrequency (RF) probe to treat chronic tendinosis of the common extensor tendon origins of the elbow (lateral epicondyle). Type of Study: Prospective, nonrandomized consecutive case series. Methods: The average age of the 13 patients was 48.3  5.5 years. Before receiving the microtenotomy, all patients had tendinosis symptoms for 6 months or longer and had failed conservative treatment. The RF-based microdebridement was performed on the symptomatic tendon using the TOPAZ Microdebrider device (ArthroCare, Sunnyvale, CA). Patients were followed-up at regular postoperative intervals for 24 months. Pain status was documented using a visual analog scale self-reported measure. Functional outcome was assessed using the upper limb DASH evaluation and grip-strength measures. Quality of life assessment was evaluated using the SF-36 questionnaire. Magnetic resonance imaging was performed at regular intervals over the follow-up period. Results: Patients reported significantly reduced pain from baseline at the 7- to 10-day postoperative examination (P  .01). Pain reduction was statistically stable from 7 to 10 days through the 24-month postoperative period (P  .01). Limb-specific functional outcomes and quality of life scores were improved over baseline values. There were no perioperative or postoperative complications related to the procedure. Conclusions: The RF-based microtenotomy procedure was safe and effective through at least 2 years. This procedure provides a valuable addition for treating patients with lateral epicondylitis associated with tendinosis who have failed conservative therapy. Level of Evidence: Level IV. Key Words: Tendinosis—Tennis elbow—Radiofrequency—Ablation—Epicondylitis—Electrosurgery—Plasma- mediated—Microtenotomy. T endinosis is a common orthopaedic condition that is often refractory to nonsurgical therapies. Basic science research and clinical study has suggested that it is a noninflammatory, degenerative condition, 1-4 clinically associated with overuse. 4-9 Tendinosis is characterized by an absence of inflammatory cells, an abundance of disorganized collagen and fibroblastic hypertrophy, and disorganized vascular hyperplasia with avascular tendon fascicles. Vascular structures are believed to be nonfunctional. 5 Other studies have also suggested that nutritional flow through the af- fected tendon is compromised, making it difficult for tenocytes to synthesize the extracellular matrix neces- sary for repair and remodeling. 10,11 A principal aim in treatment of tendinosis is to establish a biologic heal- ing response. 4 Transmyocardial revascularization (TMR) has been used successfully as a technique to improve function of the ischemic heart. Initially introduced in the 1960s as transmyocardial acupuncture, the objective was to convey blood directly from the ventricular cavity into myocardial tissue or coronary vessels. 12-14 The acu- puncture method did not prove to be as clinically successful as anticipated in the longer term. 15 With From the San Diego Sports Medicine and Orthopedic Center (J.P.T., J.C., V.M., R.H.); the Department of Orthopedics, Univer- sity of California, San Diego (J.P.T., D.A.), La Jolla; and San Diego Arthroscopy and Sports Medicine Fellowship (J.P.T., J.C., V.M.), San Diego, California, U.S.A. Supported by the Docere Foundation, San Diego, and Arthro- Care Corporation, Sunnyvale, California. Address correspondence and reprint requests to James P. Tasto, M.D., 6719 Alvarado Rd, Suite 200, San Diego, CA 92120, U.S.A. E-mail: doctas007@aol.com © 2005 by the Arthroscopy Association of North America 0749-8063/05/2107-4122$30.00/0 doi:10.1016/j.arthro.2005.03.019 851 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 21, No 7 (July), 2005: pp 851-860