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Try this before you have a Tenex procedure for your Achilles tendon

Updated: Dec 20, 2023

A Tenex procedure for your Achilles tendon pain is a minimally invasive type of surgery. While Tenex has some advantages over other types of surgery, it still shouldn’t be your first option for pain relief for Achilles tendinopathy. This article explains what you should rather do first and also what pitfalls to avoid. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

Learn about the pros and cons of Tenex for Achilles tendonitis or tendinopathy.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

We also made a video about this:

How surgery for Achilles tendonitis works

Your Achilles tendon consists mostly of collagen fibres arranged parallel to each other, and this is what makes it so strong. When you get Achilles tendonitis, a part of the tendon is injured, and the collagen fibres are in disarray. So, without the parallel structure, the tendon is a bit weaker, but only in that specific area. Your tendon then becomes painful because it cannot cope with the workload that it usually has to deal with.

The aim of all surgery for Achilles tendonitis, including Tenex, is to remove or decrease the patient’s pain by removing the painful, damaged part of the tendon.

The traditional way to do this was open surgery. The surgeon would make a cut and go in with a scalpel and cut out the damaged tissue. This caused a lot of scar tissue and carried some risk of infection.

Nowadays they mostly do keyhole surgery, where they make a small incision, and they go in through that and cut away the injured parts.

Open surgery creates a lot of scar tissue, whereas minimally invasive procedures like Tenex don't.
Open surgery creates a lot of scar tissue, whereas minimally invasive procedures like Tenex don't.

How Tenex for Achilles tendonitis works

Tenex uses ultrasound technology instead of an old-fashioned scalpel to remove damaged tissue.

  1. An ultrasound scan is used to identify the damaged area of the Achilles tendon.

  2. The patient is given a local anaesthetic, after which an incision is made at the affected area.

  3. A small probe with a point like a needle is inserted through the incision.

  4. The instrument then emits high-frequency vibrations (ultrasound waves) that break up the damaged tissue. The frequency is set so that it doesn’t damage the surrounding healthy tissue.

  5. A system within the probe removes the broken-up tissue.

Advantage of using Tenex: So, if we look at types of surgery, Tenex is a really good option if you absolutely have to have surgery, because it is less likely to cause a lot of scar tissue, it's minimally invasive, and you're out of the procedure within a few minutes.

Tenex is still surgery

However, there are some orthopaedic clinics out there that offer the Tenex procedure that try to make it sound as if it is not surgery, along the lines of, “You don't really have to worry about it, just go in and have it done, and all your pain will magically disappear.”

This claim is just not true. The official Tenex website is at pains to distinguish their procedure from “conventional surgery” or “open surgery”, but in their product overview they explain that it does involve making an incision.

Also, like other types of surgery, it changes the structure of your tendon by removing a part of it.

Why Tenex is not a silver bullet for Achilles tendonitis

It doesn’t restore tendon strength

Tenex and other types of surgery for Achilles tendonitis may remove or decrease your pain (and this is not the case for everyone), but it does nothing to restore the tendon’s strength back to normal. And its strength won’t come back if you don’t do anything, i.e. if you just rest it.

Because the surgery has changed the structure of the tendon by removing a part of it, you need a rehab programme that strengthens the rest of the tendon, so it is able to cope with the loads created by your daily activities and sport.

This means that you can’t just dive right back into your sport and your normal day-to-day activities directly or soon after the surgery – you will likely reinjure your Achilles tendon because it is still as weak as it was before the surgery.

Going back to your sport before you've properly strengthened your tendon often causes Achilles injuries to recur.
Going back to your sport before you've properly strengthened your tendon often causes Achilles injuries to recur.

Tenex procedure complications

The following complications have been reported in the research:

  • Deep vein thrombosis (DVT)

  • Spontaneous rupture of the Achilles tendon

  • Wound infections

  • Wound rupture

  • Hematoma (collection of blood in area) and bruising

  • Nerve injury

  • Pseudo gout flare-ups.

Low incidence: Even though these complications sound pretty scary, it should be noted that they are quite rare. Studies that look at large numbers of patients are still lacking, but in a review of 189 tendon scraping procedures performed using Tenex, only 1.6% (3/189, two of which was serious) of the patients experienced complications. Fick et al. had even better results in that only 0.7% (2/298) of procedures caused minor complications.

Following a comprehensive rehab plan after your Tenex procedure may reduce the risk of serious complications.
Following a comprehensive rehab plan after your Tenex procedure might reduce the risk of serious complications.

How to avoid DVT post Tenex: We know the risk of getting a DVT increases when you wear a boot. Adding gentle pain-free movements of the ankle, knee, and hip to your rehab plan (starting 24 hours after the procedure) can help to improve your circulation and reduce this risk. This is also what Fick and colleagues did.

How to avoid Achilles ruptures post Tenex: Wondering how Tenex can cause Achilles ruptures? The likely explanation is that people simply increased their activities too quickly after the procedure (because they felt much better) and overloaded their tendons. This might have been prevented had they taken the time to first strengthen their tendons properly.

Fick et al. made all their patients follow a gradual, progressive rehab plan (lasting 12 weeks) after their Tenex procedure, which likely contributed to the lack of serious complications reported in their study.

Long-term results are unclear

In research terms, the jury is still out on the long-term benefits of Tenex for Achilles tendonitis. A recent review of the available research into the effectiveness of Tenex surgery for the treatment of tendinopathies could find only one high-quality study on Tenex for Achilles tendinopathy. It showed “modest improvement in the short term, but long-term data are lacking”.

So, we know that Tenex and other types of surgery may have a good short-term effect in terms of pain relief, but we don’t know how these treatments compare to other types of treatment over a period of 12 months or longer.

What to do (and what not) before you consider Tenex for your Achilles pain

What we do know is that the current research on the effect of surgery (in general) on Achilles tendonitis advises that you should only consider surgery if your Achilles isn’t better after you have tried at least 12 months of a carefully progressed strength training rehab programme.

The correct type of rehab programme should take the following things into account when it is prescribed to you by a physiotherapist or other medical professional:

  • Your tendon’s current strength.

  • Whether any of the exercises cause you pain.

  • Daily activities other than your rehab exercises that put strain on your Achilles tendons.

  • Your aims in terms of what level of sport/activity you would like to get back to.

  • Gradual progression in the difficulty of the exercises based on how you experience your current level of difficulty and how well your tendon tolerates them.

Apposed to surgery, exercise can restore the strength in your Achilles tendon.

Some people do try other things before wanting to go for surgery, but often these are the wrong options.

  • Wearing an orthopaedic boot for more than two weeks. This actually weakens the tendon even further through inactivity and the tendon quickly becomes painful again after you have removed the boot.

  • Stretches. This will likely increase the pain in an Achilles tendon that’s already painful.

  • Painful exercises. The load you put through that tendon in rehab has to be at the level that the tendon can actually sustain. If the exercise is making it feel worse, it's either the load's too much or the range of motion you're working through could be too much.

  • The wrong type of exercise. The very commonly prescribed exercise regime for Achilles tendinopathy is the Alfredson method, where you do eccentric heel drops over the side of a step. My colleague Steph Davies explains in this article why eccentric heel drops might be the wrong type of exercise for Achilles tendonitis in some cases.

So, in a nutshell: If you’re going to have to do a proper rehab programme anyway to regain your Achilles tendon’s former strength after Tenex or any other surgical procedure, why not try such a programme in the first place and thereby possibly avoid having to go for surgery at all?

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

Meet the TMA physios

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

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About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.



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