Background Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision. Methods The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current recommended treatment (steroid injection) in people diagnosed with a refractory tennis elbow. Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints from 12 to 48 weeks. Results During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in visual analogue scale score (VAS) of pain, tenderness during palpation, pain-free grip strength (PFGS) and Nirschl staging than the corticosteroid group. Conclusions For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis. Trial registration: The National Health Commission announced the "ethical review measures for biomedical research involving people" in 2019, which was not mandatory in previous studies.

Background Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision. Purpose The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current standard of care (steroid injection) in people diagnosed with a refractory tennis elbow. Methods Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints at 1, 6, 12, 24 and 48 weeks. Results During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in nearly all outcome measures than the corticosteroid group. Conclusions For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis.

Introduction. Osteonecrosis of the femoral head (ONFH) is an intractable disease that causes progressive femoral head collapse, severe pain, and gait disturbance. We report a case of avascular necrosis of the femoral head following an occult femoral neck stress fracture, which shows that early diagnosis and treatment are very important. Case report. A 55-year-old woman presented to our department with a chief complaint of low back pain that radiated into the left anterolateral thigh for 2 months Her left anterolateral thigh became progressively more painful over a period of about 2 weeks. No abnormal findings indicative of ONFH or an occult fracture of the femoral neck were detected by X-ray or computed tomography (CT), but an occult insufficiency fracture of the left femoral neck was identified on magnetic resonance imaging (MRI). The diagnosis of femoral neck stress fracture was delayed, resulting in femoral head necrosis. The fracture was treated with total hip arthroplasty and the resected femoral head was subjected to histopathology. Based on the histopathological findings, the final diagnosis of this case was ONFH with an occult fracture of the left femoral neck. Clinical symptoms were relieved postoperatively. Conclusion. In patients presenting with a suspected stress fracture of the femoral neck, early MRI examination is recommended to avoid femoral head necrosis due to a delayed diagnosis.