PERCUTANEOUS ELECTROLYSIS IN THE TREATMENT OF TENDINOPATHY – A SYSTEMATIC REVIEW
Abstract
Introduction: Percutaneous electrolysis (PNE/EPI) is a minimally invasive technique used in the management of tendinopathies. The mechanism of action of this compound is based on the induction of a localised electrochemical reaction, which in turn triggers a controlled inflammatory response. This inflammatory response serves to promote the resorption of degenerated tissue and to stimulate collagen regeneration. In recent years, this method has gained increasing popularity as an alternative or adjunct to conventional conservative therapies, such as eccentric exercise, extracorporeal shockwave therapy (ESWT), or platelet-rich plasma (PRP) injections. A mounting body of clinical evidence, encompassing randomised controlled trials, has emerged to support the efficacy of this approach in alleviating pain and enhancing function in patients afflicted with chronic tendinopathy..
Objective: This systematic review aims to evaluate the existing evidence regarding the effectiveness and clinical relevance of percutaneous electrolysis in the treatment of tendinopathy.
Materials and Methods: The article is based on scientific literature sourced from PubMed and Google Scholar.
Results: PNE demonstrates beneficial effects on pathologically altered tendons. The majority of studies report pain reduction and functional improvement in patients. The combination of PNE with other therapeutic modalities shows a synergistic effect. Nevertheless, further comparative analyses and meta-analyses are required to definitively establish the superiority of PNE over other treatment approaches.
Conclusions: PNE may serve as a core component in the treatment of tendinopathy. However, standardization of treatment parameters—such as current intensity and therapeutic protocols—is necessary to ensure consistency and reproducibility of outcomes.
References
Scott A, Squier K, Alfredson H i in. ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. Br J Med. 2019;54(5):260-262. doi:10.1136/bjsports-2019-100885
Kozlovskaia M, Vlahovich N, Ashton KJ, Hughes DC. Biomedical Risk Factors of Achilles Tendinopathy in Physically Active People: a Systematic Review. Sports Med Open. 2017;3(1). doi:10.1186/s40798-017-0087-y
Opdam KT, Zwiers R, Wiegerinck JI, van Dijk CN. Increasing consensus on terminology of Achilles tendon-related disorders. Knee Surg Sports Traumatol Arthrosc. 2021. doi:10.1007/s00167-021-06566-z
Lasso Arequipa TA, Navarrete Pérez JC, Camino Ortega CN, Padilla Paredes SA, Criollo Pullupaxi ED. Intrinsic and Extrinsic Risk Factors for Tendinopathies. Cienc Reflex. 2025;4(1):434-461. doi:10.70747/cr.v4i1.115
Dean BJ, Dakin SG, Millar NL, Carr AJ. Review: Emerging concepts in the pathogenesis of tendinopathy. Surgeon. 2017;15(6):349-354. doi:10.1016/j.surge.2017.05.005
Mead MP, Gumucio JP, Awan TM, Mendias CL, Sugg KB. Pathogenesis and management of tendinopathies in sports medicine. Transl Sports Med. 2018;1(1):5-13. doi:10.1002/tsm2.6
Dean BJ, Dakin SG, Millar NL, Carr AJ. Review: Emerging concepts in the pathogenesis of tendinopathy. Surgeon. 2017;15(6):349-354. doi:10.1016/j.surge.2017.05.005
Abate M, Gravare-Silbernagel K, Siljeholm C i in. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Amp Ther. 2009;11(3):235. doi:10.1186/ar2723
Xu Z, Hou W, Zhang T, Chen R, Skutella T. Exploring molecular and cellular signaling pathways: Unraveling the pathogenesis of tendinopathy. J Orthop Transl. 2025;51:298-311. doi:10.1016/j.jot.2025.02.003
Ackermann PW, Phisitkul P, Pearce CJ. Achilles tendinopathy – pathophysiology: state of the art. J ISAKOS. 2018;3(5):304-314. doi:10.1136/jisakos-2017-000164
Challoumas D, Crosbie G, O’Neill S, Pedret C, Millar NL. Effectiveness of Exercise Treatments with or without Adjuncts for Common Lower Limb Tendinopathies: A Living Systematic Review and Network Meta-analysis. Sports Med Open. 2023;9(1). doi:10.1186/s40798-023-00616-1
Burton I. Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review. Sports Med Sci. 2022;4(1):8-17. doi:10.1016/j.smhs.2021.11.002
van der Vlist AC, Winters M, Weir A i in. Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. Br J Med. 2020:bjsports—2019-101872. doi:10.1136/bjsports-2019-101872
Rosen AB, Wellsandt E, Nicola M, Tao MA. Current Clinical Concepts: Clinical Management of Patellar Tendinopathy. J Athl Train. 2021. doi:10.4085/1062-6050-0049.21
Nadeau-Vallée M, Ellassraoui S, Brulotte V. Platelet-rich plasma (PRP) injections as a second-line treatment in patients with tendinopathy-related chronic pain and failure of conservative treatment: a systematic review and meta-analysis. Pain Med. 2025. doi:10.1093/pm/pnaf022
Ling SK, Mak CT, Lo JP, Yung PS. Effect of Platelet-Rich Plasma Injection on the Treatment of Achilles Tendinopathy: A Systematic Review and Meta-analysis. Orthop J Med. 2024;12(11). doi:10.1177/23259671241296508
Loiacono, Palermi, Massa i in. Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review. Medicina. 2019;55(8):447. doi:10.3390/medicina55080447
Tarantino D, Mottola R, Resta G i in. Achilles Tendinopathy Pathogenesis and Management: A Narrative Review. Int J Environ Res Health. 2023;20(17):6681. doi:10.3390/ijerph20176681
Rodríguez-Sanz J, Rodríguez-Rodríguez S, López-de-Celis C i in. Biological and Cellular Effects of Percutaneous Electrolysis: A Systematic Review. Biomedicines. 2024;12(12):2818. doi:10.3390/biomedicines12122818
Asensio-Olea L, Leirós-Rodríguez R, Marqués-Sánchez MP, de Carvalho FO, Maciel LY. Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis. Clin Rehabil. 2022:026921552211442. doi:10.1177/02692155221144272
Jorda A, Campos-Campos J, Aldasoro C i in. Protective action of ultrasound-guided electrolysis technique on the muscle damage induced by notexin in rats. PLOS ONE. 2022;17(11):e0276634. doi:10.1371/journal.pone.0276634
Ramos-Barbero M, Pérez-Jiménez A, Serrano-Carmona S, Mokhtari K, Lupiáñez JA, Rufino-Palomares EE. The Efficacy of Intratissue Percutaneous Electrolysis (EPI®) and Nutritional Factors for the Treatment of Induced Tendinopathy in Wistar Rats: Hepatic Intermediary Metabolism Effects. Int J Mol Sci. 2024;25(13):7315. doi:10.3390/ijms25137315
Valera-Garrido F, Margalef R, Bosque M, Minaya-Muñoz F, Santafé MM. Percutaneous Needle Electrolysis Accelerates Functional Muscle Regeneration in Mice. Appl Sci. 2022;12(19):10014. doi:10.3390/app121910014
Abat F, Gelber PE, Polidori F, Monllau JC, Sanchez-Ibañez JM. Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) and eccentric exercise in the treatment of patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2014;23(4):1046-1052. doi:10.1007/s00167-014-2855-2
Ferreira MH, Araujo GA, De-La-Cruz-Torrez B. Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis. J Sport Rehabil. 2024:1-10. doi:10.1123/jsr.2024-0009
Augustyn D, Paez A. The effectiveness of intratissue percutaneous electrolysis for the treatment of tendinopathy: a systematic review. S Afrn J Sports Med. 2022;34(1). doi:10.17159/2078-516x/2022/v34i1a12754
Rodríguez-Huguet M, Góngora-Rodríguez J, Rodríguez-Huguet P i in. Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial. J Clin Med. 2020;9(6):1837. doi:10.3390/jcm9061837
Rodríguez-Huguet M, Góngora-Rodríguez J, Lomas-Vega R i in. Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial. J Clin Med. 2020;9(7):2068. doi:10.3390/jcm9072068
Prospective Analysis of the Beneficial Effects of Intratissue Percutaneous Electrolysis (EPI) Combined with Eccentric Exercise in the Treatment of Chronic Achilles Tendinopathy. J Orthop Res Ther. 2020. doi:10.29011/2575-8241.001173
Fakontis C, Iakovidis P, Lytras D i in. Efficacy of percutaneous needle electrolysis versus dry needling in musculoskeletal pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2023:1-14. doi:10.3233/bmr-220408
Ye Z, Yuan Y, Kuang G i in. Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26(1). doi:10.1186/s12891-025-08566-3
Arthur Vithran DT, Xie W, Opoku M, Essien AE, He M, Li Y. The Efficacy of Platelet-Rich Plasma Injection Therapy in the Treatment of Patients with Achilles Tendinopathy: A Systematic Review and Meta-Analysis. J Clin Med. 2023;12(3):995. doi:10.3390/jcm12030995
Majidi L, Khateri S, Nikbakht N, Moradi Y, Nikoo MR. The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized control trials. BMC Sports Sci Med Rehabil. 2024;16(1). doi:10.1186/s13102-024-00884-8
Paantjens MA, Helmhout PH, Backx FJ, van Etten-Jamaludin FS, Bakker EW. Extracorporeal Shockwave Therapy for Mid-portion and Insertional Achilles Tendinopathy: A Systematic Review of Randomized Controlled Trials. Sports Med Open. 2022;8(1). doi:10.1186/s40798-022-00456-5
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. doi:10.1016/s0140-6736(10)61160-9
Lazzarini SG, Buraschi R, Pollet J, Bettariga F, Pancera S, Pedersini P. Effectiveness of Additional or Standalone Corticosteroid Injections Compared to Physical Therapist Interventions in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2025. doi:10.1093/ptj/pzaf006
Ferreira MH, Araujo GA, De-La-Cruz-Torrez B. Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis. J Rehabil. 2024:1-10. doi:10.1123/jsr.2024-0009
Rodríguez-Sanz J, Rodríguez-Rodríguez S, López-de-Celis C i in. Biological and Cellular Effects of Percutaneous Electrolysis: A Systematic Review. Biomedicines. 2024;12(12):2818. doi:10.3390/biomedicines12122818
Views:
18
Downloads:
16
Copyright (c) 2025 Magdalena Rosiewicz, Karolina Bieńkowska, Anita Janda, Sylwia Bartolik, Marcin Durowicz, Iwona Górnicka, Aleksandra Pastuszek, Jan Drzymała, Urszula Kierepka
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
