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This trial investigates treatments for chronic lateral epicondylitis, also known as tennis elbow, which can cause pain and interfere with daily activities and work. The study aims to compare two treatment methods to determine if one is better than the other for relieving symptoms and improving function. It is a randomized controlled trial led by Sean Mc Millan, focusing on patients who have had symptoms for at least six months and have tried other treatments without success. Participants will be randomly assigned to receive either the Ultrasound-guided Percutaneous Tenotomy Technique Tenex procedure or Open Surgical Debridement. The Tenex procedure uses a special needle and ultrasonic energy to remove damaged tissue under local anesthesia in the surgeons office. Open Surgical Debridement is a traditional surgery involving an incision to remove damaged tissue under anesthesia in a surgery center. Both procedures target the damaged tendon area causing pain. During the study, participants will have follow-up visits at 3 weeks, 6 weeks, 3 months, 6 months, and 12 months after treatment. At each visit, their progress will be monitored through physical exams and questionnaires. The main outcome measured is the comparison of complications and functional results between the two treatments. The total participation period includes the initial screening and one year of follow-up to assess recovery and treatment effects.