A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis

Abstract

BackgroundTennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. Most cases resolve within 2 years of symptom onset, but a subset of patients will develop persistent symptoms despite appropriate conservative management. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. This procedure involves the arthroscopic release of the extensor carpi radialis brevis tendon (ECRB) origin at the elbow. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. However, in order to justify its widespread use and growing popularity, a high level of evidence study is required. The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis.MethodsWe will conduct a prospective single center, double-blind, randomized sham-controlled parallel arm trial evaluating the efficacy of arthroscopic tennis elbow release in adult patients with symptoms for at least 6 months. Patients will undergo intraoperative randomization after diagnostic arthroscopy of the elbow to receive either ECRB release (through the creation of a lateral portal) or a sham lateral portal and no ECRB release. The primary outcome will be the Mayo Elbow Performance Score (MEPS) at 1 year follow-up. Secondary outcomes will be the abbreviated Disability of the Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons elbow (ASES-e) score and grip strength at 3, 6, 12 and 24 months as well as return-to-work time, ability to return to full duty and adverse outcomes.DiscussionResults of this study will provide empirical high quality evidence to guide clinical decision-making in patients with chronic tennis elbow.Trial registrationNCT02236689 (September 8, 2014)

Evolution of the Arthroscopic Treatment of Chronic Lateral Epicondylitis-Preliminary Result

“…Elbow arthroscopy, besides being a less invasive procedure preserves the integrity of the skin and underlying tissues, causes less inflammatory reaction, and allows assessing the joint in its entirety for inspecting and ruling out associated pathologies. Many authors [1,6] have described good results with early reintegration to the daily activity after the arthroscopic treatment of the tennis elbow. Miyazaki et al [7] reported results of 20 patients operated over a period of 8 years, obtaining 65% excellent results.…”

“…It has an incidence of 4-7 per 1000 inhabitants per year. Recent studies highlight that between 1-3% of the population will suffer discomfort during the course of life [1]. It affects individuals between 35 and 50 years.…”

“…Recently, the arthroscopic release of the tennis elbow has become popular. The debridement of the degenerated tendon, the capsular release and the underlying decortication is the most commonly used technique [1,[3][4][5][6]. The best increased knowledge of the elbow anatomy and the technical improvement and safety of the arthroscopic portals have increased the reports of the arthroscopic treatment of lateral epicondylitis.…”

“…Although the tennis elbow can present itself acutely, its behavior in general is insidious, secondary to repetitive movements of extension of the wrist and prono-supination of the forearm. Lateral tendinosis is defined as a microscopic tear of the short radial extensor carpi (or extensor carpi radialis brevis), which is located on the lateral proximal side, below the tendon of the long radial extensor of the carpus (extensor carpi radialis longus), covers the radial head, and runs between the long supinator and the long radial extensor of the carpus [1,2]. The short radial extensor of the carpus has a weak biomechanical point where it connects to the joint capsule without covering the supinator muscle.…”

Comparative Study: Arthroscopic Versus Open Tennis Elbow Release

“…One of the most common elbow pathology is the tennis elbow or lateral epicondylitis that commonly affects middle-aged individuals and can cause major discomfort and disability. 1 This condition usually affects persons between 35 and 50 years old and 1-3% of the population may complain of lateral side elbow pain throughout their lifetime. The recorded incidence of tennis elbow is 4-7 per 1000 per year.…”