Exploring intensity-dependent echogenic response to percutaneous electrolysis in tendon tissue: a cadaveric study

Abstract

Background: Percutaneous electrolysis (PE) is an emerging therapeutic approach for tendinopathies, applying a galvanic current through a dry-needling needle to induce regenerative tissue responses. However, current dosing strategies are often empirical and lack objective physiological feedback. Objective: This study aimed to evaluate the echogenic effects of different galvanic current intensities on cadaveric tendon tissue using quantitative ultrasound. Methods: An ex vivo study was conducted on 29 cadaveric patellar tendon samples, each exposed to a single intensity (0–10 mA for 1 s). Quantitative ultrasound analysis was performed post-intervention, and echogenic variables were extracted using UZ eDosifier software. A composite variable, Electrolysis_UZ_Dose, was created via multiple regression to capture the overall ultrasound-visible changes. Data were analyzed using correlation, regression models, and dose–range comparisons. Results: An intensity-dependent response was observed in key echogenic parameters. Minimal changes occurred at low intensities (0–2 mA), whereas a progressive response emerged between 2 and 6 mA. Beyond 6 mA, a plateau effect suggested either tissue saturation or imaging limitations due to gas-induced acoustic shadowing. The Electrolysis_UZ_Dose variable strongly correlated with applied intensity (R2 = 0.732). Conclusions: This study suggests an intensity-dependent echogenic effect of PE on tendon tissue in key ultrasound-derived parameters (A_Number, A_Area, A_Perimeter, A_Homogeneity, and A_ASM). However, as this study was conducted under experimental conditions with a single 1 s application per sample, the results should not be extrapolated to clinical practice without further validation.