TenJet for Achilles tendonitis: how the procedure works, who it suits, and recovery

You’ve done months of heel drops. Maybe you tried shockwave or a boot. Your Achilles still aches with every first step. This guide covers TenJet for Achilles tendonitis in depth: how the saline jet works on a tendon, how it differs from Tenex, who is a good candidate, what happens on the day, and what recovery looks like week by week. For the full range of care, see our Achilles tendonitis treatment guide.

When does Achilles tendonitis need a procedure?

When the tendon has stopped healing on its own. Exercise is the right first step, but it doesn’t work for everyone. In one study, a 12-week heel-drop program gave a satisfactory result in 89% of tendons with pain in the middle of the tendon, but in only 32% with pain where it meets the heel bone.^[5] In a trial of people whose earlier care had already failed, only 28% were recovered or much improved four months into the same kind of exercise.^[6] One review estimates that 10% to 30% of people with pain at the heel bone need surgery.^[7]

The American Academy of Orthopaedic Surgeons says surgery is considered when pain hasn’t improved after six months of non-surgical treatment.^[3] Open surgery works. In 465 operations for pain at the heel bone, 89.6% had good or excellent results.^[7] But it is a big recovery. Many patients need up to 12 months of rehabilitation to reach their full improvement.^[3]

Smaller approaches recover faster. In a 2025 review, people were back to daily activities about 7 weeks after camera-guided surgery, versus 22 weeks after open surgery, with similar final scores.^[8] Small-incision procedures go further. With Tenex at the Achilles, that has meant a cut of about 5 mm, numbing medicine only, and a boot for about two weeks.^[9,4] The results have been encouraging:

Study	Patients	Result
Hall 2026[4]	56 (48 at the heel bone, 8 midportion)	Pain down about 3 points and function up 25 points at 1 year; no procedure complications
Chimenti 2019[9]	34, at the heel bone	Moderate or severe pain fell from 68% to 15%; every patient with recorded work status was back at work by 12 weeks
Freed 2019[10]	25, at the heel bone	84.6% success, counting two repeat procedures

Freed’s team used ultrasound-guided “microresection” and its abstract doesn’t name a device. TenJet uses the same principle with a different cutting tool.

Swipe sideways to see the whole drawing.

What is TenJet and how does it work on the Achilles?

TenJet is made by HydroCision. The FDA cleared a TenJet device in 2019 through its 510(k) process, which checks that a new device is substantially equivalent to ones already sold.^[1]

• The tool. A 12-gauge needle, about 2.8 mm wide, carries a saline jet that reaches up to 14,000 pounds per square inch.^[2]
• How it cuts. The jet runs across a small window at the tip. Its flow creates suction, so it cuts the damaged tendon and pulls it out at the same time, while sparing healthier fibers.^[2,11]
• How it’s aimed. The doctor watches the tip on ultrasound the whole time and stops when the dark, damaged area shrinks.^[11]
• What lab work shows. On cow ankle tendon with chemically created damage, the jet removed the damaged tissue with negligible disruption of the healthy tissue around it.^[12]

The maker lists Achilles tendinosis among the conditions TenJet treats.^[13]

TenJet vs Tenex for the Achilles: what’s the difference?

Both remove damaged tendon through a small cut under ultrasound. Tenex uses an ultrasonic cutting tip; TenJet uses the saline jet.^[9,2] No study has compared them, so neither can be called better.

Two practical differences matter at the Achilles:

• Research. Tenex has published Achilles results. TenJet doesn’t yet.^[4,14]
• Bone. In the 2026 Tenex study, the team also shaved down heel spurs and a Haglund’s bump (a bony bump on the back of the heel) through the same small cut when needed.^[4] TenJet has removed calcium from a knee ligament in two case reports, one of which needed a small open incision to finish,^[15,16] but we found no report of it removing heel bone.

That’s why the shape of your heel bone on X-ray helps decide which tool, or which operation, fits you. Our Tenex and TenJet overview compares them for the heel and the Achilles.

What does the TenJet evidence show?

As of November 2026, after searching PubMed, ClinicalTrials.gov and the wider web, these are the main published TenJet results:

Study	Where	Patients	Result
Dakkak 2026[2]	Hip (gluteal tendons)	46	Pain 5.8 to 2.1 out of 10 at 6 months; one adhesive rash; no device problems
Strauser-Curtis 2022[11]	Elbow	29	Pain 5.1 to 0.5 at 1 year; no procedure complications; 2 later had open surgery
Dakkak 2023[17]	Elbow	100	Elbow scores improved at 1 year; no complications; none needed open surgery
Wong 2018[12]	Cow tendon (lab)	None	Damaged tissue removed, healthy tissue spared

None of these is the Achilles. The only TenJet patient registry listed on ClinicalTrials.gov enrolls elbow, hip and shoulder tendons, not the Achilles.^[18] In our view, the hip tendons are the closest match, since like the Achilles they bear your weight. In that study, pain had already dropped by two weeks.^[2]

One more data point supports a small procedure over more therapy. In a randomized trial of 38 people with midportion pain, a radiofrequency wand did better than physical therapy at two years: pain fell from 7.2 to 1.0, versus 5.9 to 3.1.^[19] That isn’t TenJet, but it is randomized evidence that a small tendon procedure can outperform continued therapy.

Who is a good candidate for TenJet for Achilles tendonitis?

You may be a candidate if pain has lasted six months or more despite good care,^[3] and ultrasound or MRI shows tendinosis that can be targeted. The TenJet registry required that confirmation, at least three months of non-surgical care, and no full-thickness tear.^[18]

Another option may suit you better if:

• You have a large Haglund’s bump or heavy calcium. In the Tenex study, these went with about 13 to 15 points less gain in function.^[4] Removing the bump, with Tenex or an open operation, may matter. See Haglund’s deformity.
• Disease runs along much of the tendon. With an older small-cut technique, researchers advised that open surgery may be preferable for widespread disease.^[20]
• More than half the tendon is damaged. That can call for a tendon transfer.^[3]
• Your calf is tight despite stretching. Calf lengthening may fit instead.^[3]

What happens on the day?

Based on the TenJet studies:

1. Numbing. Local anesthetic goes in under ultrasound, through the skin and down to the tendon.^[11] In the hip study, 45 of 46 people needed nothing more.^[2]
2. The cut. A scalpel tip makes a small nick.^[17]
3. Treatment. The jet ran for an average of about 3.65 minutes in the elbow study.^[11] In the hip study, half of room times were 30 to 45 minutes.^[2]
4. Closing. Adhesive strips, no stitches.^[11]
5. Home the same day.^[2]

TenJet Achilles tendon recovery: week by week

No TenJet Achilles recovery data have been published. This timeline comes from Tenex Achilles protocols, with TenJet findings from other tendons where they exist. Your plan may differ.

Time	What the sources report
Day 1	Out of the boot for gentle, pain-free ankle motion; no need to sleep in it.[9]
Weeks 0 to 2	Walking as tolerated in a boot, with a walking aid until walking in it is pain-free.[4]
Week 2	Wean out of the boot into a regular shoe and start strengthening.[9] In the TenJet hip study, the wound check came at two weeks, and most incisions had healed.[2]
Weeks 2 to 6	No heavy use: no long walks, running or jumping.[9]
Week 12	In one Tenex series, half were back to their previous activity level, and everyone with recorded work status was back at work.[9]
Months 3 to 4	Most people were released to full activity.[4]

How does TenJet compare with open surgery, shockwave, PRP and cortisone?

No study has compared TenJet with any of these. Here is what each has shown.

• Open surgery. It works, with 89.6% good or excellent results, but the average complication rate was 18.3%.^[7] For midportion disease, complications were 5.3% with minimally invasive approaches versus 10.5% with open ones, a trend rather than a firm difference.^[21]
• Shockwave. Results are mixed. Shockwave beat eccentric exercise in one 50-person trial of pain at the heel bone,^[6] while a 2026 review of nine trials found no clinically meaningful gain over sham treatment.^[22] We offer shockwave therapy, and it needs no incision.
• PRP. A 2025 review of six trials found PRP did not improve pain or function compared with placebo.^[23]
• Cortisone. In a trial of 100 people with midportion pain, a cortisone shot added to exercise improved scores more than a placebo shot at six months.^[24]

What are the risks and side effects?

With TenJet in other tendons, one person in 46 had a rash from the adhesive, and the elbow studies reported no procedure complications.^[2,11,17] With Tenex at the Achilles, there was one superficial skin infection in 40 procedures.^[9] An earlier series of the same ultrasonic procedure described a blood clot and six people whose pain did not improve or got worse.^[9] Its authors concluded that small-incision ultrasonic tenotomy is a surgical procedure with complications similar to other Achilles surgery.^[25]

The limits. No TenJet study in the Achilles has been published, so the Achilles results above come from Tenex and related techniques.^[14] The TenJet studies have no comparison group, the hip study was sponsored by the maker, and several authors consult for it.^[2,17] In the 2026 Tenex study, 30 of the 39 who answered were satisfied, yet only 21 said their symptoms were acceptable, and more than half still had occasional pain or stiffness.^[4] A lead Tenex researcher has consulted for the company.^[9] Please call our office at 908-215-5953 to inquire about your insurance.

How we decide

Dr. Efe Ozturk is a Foot and Ankle Surgeon and podiatrist who offers both TenJet and Tenex. We examine the tendon, use X-ray and in-office ultrasound to map the damage and any bone bump, and check that exercise had a fair trial. Then we lay out the options side by side: TenJet, Tenex, calf lengthening, or open surgery through our Center for Lower Extremity Surgery (external site). See our Achilles tendon care page. We see patients in Lyndhurst, Paramus and Millburn, NJ.

Common questions

Is the TenJet procedure painful?

The area is numbed first. The maker notes some discomfort when the anesthetic goes in and soreness as it wears off.^[13] In the hip study, 8 of 46 people used a prescription pain medicine at two weeks, and by three months most used none.^[2]

Does TenJet work for Achilles tendonitis?

It hasn’t been studied in the Achilles yet. Pain improved in TenJet elbow and hip studies,^[11,2] and the related Tenex procedure has encouraging Achilles results.^[4]

How does TenJet compare with PRP for the Achilles?

No study has compared them. PRP did not beat placebo in a 2025 review of Achilles trials.^[23] TenJet removes the damaged tissue itself.

What are the side effects of TenJet?

The maker notes soreness as the numbing wears off, and in the hip study most incisions had healed by two weeks.^[13,2] Reported problems with TenJet have been minor, such as an adhesive rash.^[2] See the risks section above for Tenex reports at the Achilles.

When to see a Foot and Ankle Surgeon or podiatrist