The Ultrasound-Guided Electrolysis Therapy (USGET) in Sports Medicine: Clinical Evidence and Molecular Insights

Objectives: To synthesize molecular and clinical evidence on Ultrasound-Guided Electrolysis Therapy (USGET) for sports-related tendon and muscle disorders, emphasizing its modulatory tissue effects and the importance of ultrasound guidance.
Methods: Narrative clinical review including randomized trials, cohort studies, long-term follow-ups, preclinical models, and molecular investigations on USGET in tendinopathies and muscle injuries.
Key Results: On a molecular level, USGET applies a galvanic current that modulates tissue responses: in chronic tendinopathies, it initiates a controlled inflammatory reaction promoting collagen-I remodeling, among others; in acute muscle injuries, it dampens excessive inflammation and promotes inflammation resolution. Preclinical data confirm reductions of pro-inflammatory mediators and stimulation of angiogenic and reparative pathways. Clinically, the strongest evidence is in patellar tendinopathy, including randomized controlled trials and long-term follow-up. Additional supportive data exist for lateral epicondylitis, subacromial pain syndrome, and adductor-related groin pain. Long-term studies demonstrate sustained improvement in function and pain reduction. A clear dose–response effect exists: adequate dosing is required for regeneration, while excessive current can cause local damage, underscoring the need for protocol standardization. Ultrasound guidance enhances safety and precision, allowing targeted application to degenerative regions while minimizing risk to surrounding structures.
Conclusions: USGET is a minimally invasive therapy with growing evidence, particularly in chronic tendinopathy, and acts through tissue-specific modulation. Standardization of dosing parameters, further comparative trials, and integration of real-world data registries are necessary to consolidate its role in sports medicine practice.

Key Words: Prevention, Muscle Disorder, Tendinopathy, Muscle Injury, Orthobiologics, Regeneration, Minimal Inveasive Therapy

Tendinopathies are among the most frequent overuse injuries in sports medicine, characterized by pain, functional impairment, and structural alterations of tendon tissue. They affect multiple anatomical sites -specially the Achilles, patellar, rotator cuff, and elbow tendons- and are a major cause of time lost from training and competition. High mechanical demands with repeated stretch–shortening cycles (e.g., jumping, cutting) increase the risk and can perpetuate symptoms.
As a model condition, patellar tendinopathy (PT) illustrates the magnitude of the problem: a recent systematic review and meta-analysis including 28,171 participants reported an overall prevalence of 18.3% in athletes versus 0.1% in the general population; prevalence rises with age and varies by sport (volleyball 24.8%, basketball 20.8%, soccer 6.1%) (20). Despite advances in exercise-based rehabilitation and adjunct modalities, a substantial proportion of patients remain symptomatic, seek repeated care, or reduce sporting activity.
Ultrasound-Guided Electrolysis Therapy (USGET) – also termed Percutaneous Electrolysis has emerged as a minimally invasive technique that delivers a galvanic current via a fine acupuncture-needle into the pathological tissue under real-time ultrasound control (figure 1). A recent systematic review summarizes biological and cellular effects supporting a regenerative rationale for this approach (22). This Clinical Review synthesizes molecular mechanisms, preclinical findings, clinical evidence, and future perspectives of USGET in sports medicine.

Electrochemical Trigger and Dose-Response

When galvanic current is applied through a needle in tissue, electrolysis occurs at the cathode, producing hydroxyl ions (OH-) and sodium hydroxide (NaOH). This creates a temporary localized alkaline microenvironment that may aid regenerative cell-migration and re-initiate stalled healing in degenerative tendon tissue. Crucially, the effect is dose-dependent: at controlled doses, the stimulus is regenerative; at excessive doses, NaOH is cytotoxic and can produce cell damage – demonstrated in animal models – hence the need for strict parameterization (1, 21).

Chronic Tendinopathy: Controlled Pro-Inflammatory Remodeling-Stimulus 

In chronically degenerated tendons, the healing process often stalls in a dysrepair state characterized by disorganized collagen, neovascularization, persistent nociceptive drive, and low-grade, non-resolving inflammation (10). USGET appears to act as a biological enhancer of tendon healing through several mechanisms. First, galvanic current has been shown to activate the NLRP3 inflammasome, a key regulator of inflammation, eliciting a transient IL-1β/IL-18 response that primes tissue remodeling. This process is also associated with the activation of the proinflammatory M1-macrophage phenotype. Second, matrix re-organization is promoted, with a shift toward type I collagen and a reduction in type III collagen, aligning with the restoration of a mechanically more robust tendon matrix (21). Third, angiogenesis and pro-repair signaling are stimulated, as evidenced by increased VEGF/VEGFR and PPAR-γ expression in tendon models exposed to galvanic stimulation. Finally, apoptotic clearance is facilitated through the upregulation of cytochrome c and Smac/DIABLO, indicating selective removal of damaged cells prior to matrix replacement. Taken together, these processes position USGET as a modulatory, time-limited pro-inflammatory trigger that transforms a chronic, non-resolving environment into one favoring active remodeling and structural recovery (1, 21).

Acute Muscle Injury: Resolution-Oriented Anti-Inflammatory Modulation

In acute muscle injury, excessive inflammation contributes to secondary damage and excessive fibrosis. In notexin-induced lesions on rats, USGET dampens pro-inflammatory mediators (IL-6, TNF-α, NF-κB-related chemokines) and increases anti-inflammatory cytokines (IL-10, IL-13); histology shows less necrosis and accelerated architectural repair.
From a molecular point of view, this pattern fits a pro-resolution rather than ignition role, highlighting that USGET’s effect depends on the local predominant tissue state (degenerative tendon vs. acutely injuried muscle) (3, 18).

Immunomodulation and Macrophage Phenotype

Persistent inflammatory dysregulation in human chronic tendinopathy includes macrophage infiltration (CD14+/CD68+) and expression of activation markers spanning interferon/NF-κB (often mapped to “M1-like”) and STAT-6/GCR pathways (CD206/CD163; “M2-associated”), indicating a complex, mixed activation signature rather than a simple binary phenotype (11). A systematic review confirms macrophages (alongside lymphocytes and mast cells) in chronic tendinopathy (17). While no USGET study has yet directly quantified M1↔M2 switching in vivo, the cytokine shifts seen in muscle models (IL-10/IL-13↑ with TNF-α/IL-6↓) are consistent with a microenvironment that favors an M2-like reparative profile (3, 11, 17, 18, 22). We therefore speak of immunomodulation rather than definitive polarization.

Added Benefit: Bactericidal Effects

Galvanic current demonstrates a bactericidal effect against biofilms (e.g., S. aureus, E. coli) in vitro (16). Although clinical infection data in sports settings are limited, this property plausibly adds to procedural safety when traversing potentially contaminated tracks.
In summary, molecular and preclinical evidence portrays USGET as a tissue-state–dependent modulator: it can deliver a controlled pro-inflammatory stimulus that supports remodeling in chronic tendon disorders, and an anti-inflammatory, pro-resolution stimulus in acutely injured muscle (1, 3, 10, 16, 18, 21, 22). Table 1 provides an overview of molecular and preclinical studies investigating the effects of galvanic current on tissue regeneration and repair.

The most robust body of clinical evidence is available for patellar tendinopathy (PT). In a randomized controlled trial (RTC), Abat et al. assigned 50 patients with PT either to USGET combined with eccentric exercise or to conventional electrophysiotherapy. Patients in the USGET group achieved significantly greater improvements in VISA-P scores after 2 months, experienced faster pain relief, and showed earlier functional recovery (5). At two-year follow-up, a prospective series of 84 patients with PT demonstrated persistent symptom relief and functional improvement, confirming mid-term efficacy (2). At three years, a cohort of 51 patients showed an increase in VISA-P scores from approximately 59 to 89, alongside improvements in IKDC, Kujala, and Tegner scores; most of these gains plateaued at around 6 months and were maintained thereafter (7). Long-term results extending to 10 years were reported in a cohort of 63 PT patients treated with USGET plus eccentric loading. These patients sustained their VISA-P improvements and achieved high return-to-sport rates, underscoring the durable clinical and functional benefits of this therapeutic approach, without adverse effects reported (4).
Regarding non-insertional Achilles tendinopathy, a 50-patient pilot RCT in chronic mid-portion Achilles tendinopathy found that adding three sessions of USGET to an 8-week conventional eccentric program yielded significantly greater improvements in VISA-A and VAS at 1-2-month follow-up after treatment compared to eccentrics alone, with no adverse events reported (12).
In chronic lateral epicondylopathy, the combination of USGET with stretching and eccentric loading resulted in reduced pain and improved DASH disability scores, with both short- and long-term benefits. Ultrasound imaging further indicated improvement in echogenicity and Doppler signal at the common extensor origin (23). For subacromial pain syndrome, a randomized trial demonstrated that adding USGET to eccentric shoulder exercise produced greater short-term improvements in both pain and DASH scores compared with exercise alone (8). Another randomized clinical trial found that adding ultrasound-guided percutaneous electrolysis to a manual therapy and exercise program for subacromial pain syndrome did not significantly improve disability or pressure pain sensitivity but produced greater reductions in shoulder pain and better functional outcomes (SPADI) at 3- and 6-month follow-ups without adverse events (15). In athletes with adductor longus enthesopathy, the combination of USGET and active physiotherapy achieved faster pain reduction and functional recovery than physiotherapy alone over an 8-week period (14). For hamstring tendinopathy complicated by sciatic nerve entrapment, case-based reports have documented symptom reduction following USGET (19), although controlled data are still lacking.
Across studies, USGET is delivered under ultrasound guidance, typically as an adjunct to active training with specific tendon loading protocols. Reported adverse events are mild and transient. Collectively, these data suggest that USGET + structured exercise is an effective pathway for chronic tendinopathies, with strongest evidence for the patellar tendon and supportive case series in elbow, shoulder, and groin tendons (2, 4, 5, 7, 814, 23).

Clinical Evidence for Muscle Injuries is Smaller but Aligns with Preclinical Studies

In professional soccer players with rectus femoris injuries, incorporating USGET into the rehabilitation program was associated with functional improvements and a faster return to play, with no serious adverse events reported (24).
Given the anti-inflammatory/pro-resolution profile in animal models (3, 18), targeted use during subacute phases, embedded in progressive loading and neuromuscular conditioning, is mechanistically plausible. Rigorous trials are needed to define indications, timing, and dosing.
Regarding musculoskeletal pain, a systematic review and meta-analysis of 10 RTCs found moderate-quality evidence that ultrasound-guided percutaneous electrolysis significantly reduces musculoskeletal pain (SMD =-1.15) and improves pain-related disability (SMD=0.95) across short-, mid-, and long-term follow-ups, with only minor transient soreness reported as adverse events (13). An excerpt of clinical studies is depicted in table 2.

Ultrasound Is Integral to Usget for Three Reasons: Targeting, Safety, and Reproducibility

1. Targeting: Degenerative hypoechoic foci and neovessels can be localized; power Doppler allows addressing hypervascular zones often linked to symptoms.
2. Safety: Real-time visualization of the needle reduces the risk to neurovascular structures – critical when using a modality with a dose–response and potential for off-target injury at high intensities (1, 21).
3. Reproducibility & documentation: Ultrasound standardizes lesion mapping and enables imaging biomarkers (e.g., echotexture, Doppler signals, elastography) for follow-up and research.
4. USGET combines precise needle guidance with controlled galvanic current delivery and therefore requires a structured training process. In a cadaveric model of the patellar tendon–Hoffa interface, ultrasound guidance achieved 100% accuracy compared to 80% with palpation, while iatrogenic tendon perforations were significantly lower (16% vs 52%). However, this precision came at the cost of a longer procedure time (≈55s vs 24s) and more needle insertions per target (≈ 2.6 vs 1.5), highlighting the accuracy-time trade-off and the importance of supervised learning during early adoption (9).
In short, ultrasound guidance is imperative in USGET – it is the enabling technology that translates the molecular rationale into precise, safe clinical practice.

Across randomized and prospective clinical studies, serious adverse events have been reported only rarely, while transient post-procedural soreness is common and typically self-limited (2, 4, 5, 7, 8, 14, 23). Animal models, however, have shown that excessive current density or exposure time can lead to tissue damage (1, 21). These findings translate into several practical implications. First, parameter discipline is essential: treatment should begin within conservative, published ranges, with adjustments made only within evidence-informed limits. The applied dose (mC), exposure time, number of impacts, and cumulative dose should always be documented. Second, imaging-guided confinement is critical: ultrasound guidance allows the stimulation to be focused precisely on the pathological area while avoiding tissue near neurovascular structures. This makes the USGET-procedure more time demanding than performing percutaneous electrolysis without ultrasound-guidance but assures the anatomical accuracy and evidence-based total dose application in the target-tissue. Third, strict antiseptic technique must be maintained; although galvanic current itself has bactericidal effects, this should be considered only an additional safety buffer and never a substitute for standard asepsis (16). Taken together, these points support a favorable benefit–risk profile for USGET when performed with standardized parameters and under ultrasound control.

The clinical improvement for USGET is consistent and clinically meaningful, especially in PT with RCT support and durability to 2-10 years (2, 4, 5, 7). Still, several gaps remain:
- Heterogeneity of protocols: Current intensity, pulse/exposure time, number of needling passes/sessions, and intervals vary across studies, complicating meta-analysis and dose optimization.
- Sample sizes: Most trials and cohorts are modest; larger multicenter studies are warranted.
- Comparators: There is a shortage of head-to-head trials versus other regenerative options (e.g., PRP, ESWT), and limited data on combination strategies.

Context within Regenerative Care

The therapeutic target of USGET is distinct from PRP, which delivers biologic growth factors, and ESWT with a mechanotransductive cueing. Conceptually, USGET provides a precise electro-biochemical trigger that can modulate the local microenvironment, potentially priming tissue for subsequent biologic or mechanical stimuli. While formal evidence for combined protocols is not yet available, this is a rational avenue for future research. A recent consensus from the ESSKA basic science committee positions USGET among promising options within multimodal tendinopathy care and calls for standardization and higher-level trials (6).

A sham-controlled randomized clinical trial comparing USGET vs. Dry-needling alone in patellar tendinopathy on 74 patients (Ultrasound-Guided Percutaneous Electrolysis in Patellar Tendinopathy, NCT06939491) is underway and should refine efficacy estimates, dosing parameters, and imaging correlates (25).

Combination Strategies

All positive clinical studies of USGET have integrated the procedure with structured loading programs, typically eccentric or isoinertial exercise, highlighting that USGET functions best as an adjunct within a comprehensive rehabilitation strategy. There is also a potential rationale for sequencing USGET before PRP therapy: in tendinopathy, the transient shift toward a less acidic, pro-repair milieu and associated immunomodulation induced by USGET may enhance platelet activation and growth-factor signaling if PRP is administered subsequently. However, this concept still requires confirmation in preclinical studies. In addition, mechanotransductive interventions such as ESWT or photobiomodulatory approaches such as light or laser therapy may provide complementary effects to the electro-biochemical stimulus of USGET, though specific combination protocols remain to be established.
Future priorities include: dose–response trials, comparative effectiveness against sham USGET (25), biomarker-guided phenotyping to predict responders, and long-term Real World Data registries to assess relevant PROMs.

USGET is a minimally invasive, ultrasound-guided intervention with a tissue-state–dependent, modulatory mechanism. In chronically degenerated tendon, it delivers a short-lived pro-inflammatory stimulus that promotes matrix remodeling with angiogenic support; in acutely injured muscle, it dampens cytokine excess and fosters resolution; effects that align with preclinical histology and functional recovery (1, 3, 10, 18, 21).
The strongest clinical evidence exists for patellar tendinopathy, including randomized comparisons and durable long-term outcomes, with supportive data in lateral epicondylitis, subacromial pain, and adductor-related groin pain (2, 4, 5, 7, 8, 14, 23). The overall safety profile is favorable; nonetheless, the dose–response – and the potential for tissue damage at excessive intensities – demands parameter discipline and ultrasound-guided precision (1, 21).
Positioned within regenerative sports medicine, USGET bridges physical and biological paradigms: a controllable electrochemical stimulus that resets dysregulated tendon biology and modulates acute muscle inflammation. With ongoing sham-controlled research and the development of standardized, imaging-integrated protocols, USGET has realistic potential to become a core adjunct in the treatment of refractory tendinopathies and select muscle injuries. Future studies should clarify who benefits most, how to dose optimally, and how to combine USGET with orthobiologics or other regenerative therapies to maximize durable return-to-sport and avoid injury recurrence.

Conflict of Interest
The authors have no conflict of interest.

Ethical Approval
This study is a clinical narrative review and did not involve any new research on human participants or animals. All included studies were previously published and were conducted in accordance with their respective institutional ethical guidelines.

Molecular modulation: pro-inflammatory restart in chronic tendon disorders vs. anti-inflammatory resolution in acute muscle injuries.
Clinical evidence: strongest in patellar tendinopathy with RCTs and long-term follow-up; supportive data for elbow, shoulder, achilles, and groin tendons.
Ultrasound guidance: essential for precision, safety, and reproducibility. Dose-response: regeneration requires controlled dosing strategy.
Future: ongoing sham-controlled RCT (NCT06939491); rational combinations and dose-standardization studies needed.