Evidence supports Tenex debridement as a minimally invasive yet durable alternative to surgical debridement for chronic tennis elbow. In this three-year follow-up of 20 patients (Level 4 evidence), researchers confirmed that the initial clinical and structural improvements provided by Tenex were sustained long-term. With a 100% follow-up rate at 36 months, the study reported 100% patient satisfaction and no need for secondary treatments. All participants maintained significant improvements in pain (VAS) and function (DASH). Ultrasound imaging confirmed objective biological repair: 94% saw a resolution of hypervascularity, 100% showed reduced tendon thickness, and 90% of scar reduction occurred within the first six months.