Arthroscopic Treatment of Lateral Elbow Pain Mimicking Lateral Epicondylitis: Long-term Follow-up of a Unique Surgical Protocol

Abstract

Hypothesis and/or Background: The failure rate of extensor carpi radialis brevis debridement for refractory lateral epicondylitis is reported around 15%. Our novel arthroscopic treatment is predicated on the hypothesis that lateral epicondylitis is an intra-articular problem related to a variation of the capsule-meniscal anatomy that impinges on the radiocapitellar joint. We report long-term outcomes of 35 patients treated with a novel arthroscopic resection of their capsulosynovial fringe. Methods: All patients failed nonoperative treatment but had temporary improvement with an intra-articular injection. Arthroscopic treatment involved resecting the meniscus and the proximal edge of the orbicular ligament, followed by a tendon-sparing anterolateral capsulectomy. 35 patients underwent evaluation on average 9.2 years after surgery. Outcome measures included VAS, DASH, and questions on return to sports, satisfaction, and perceived benefit of surgery. Results: Median pain scores improved from 8 of 10 preoperatively to 0 of 10 postoperatively. This change was clinically and statistically significant, with 1 patient still requiring pain medication. Median DASH score at final follow-up was 1. Overall, 30 patients rated their postoperative outcome as much better, 5 rated it as better, and 0 reported their symptoms to be unchanged or worsened. All 35 patients stated they were happy they underwent the procedure and perceived a benefit. Totally, 4 of 35 patients had postoperative complications (2 with ulnar nerve symptoms, 2 with persistent pain), with one requiring revision surgery for persistent pain. Discussion and/or Conclusions: We report promising long-term clinical and functional results of a novel arthroscopic resection of the capsulosynovial complex in lateral epicondylitis.

Is There any Difference in Clinical Outcome between Open and Arthroscopic Treatment for Tennis Elbow? A Systematic Review and Meta‐Analysis

“…It was believed that with non‐operative treatment, the symptoms of TE can be relieved in approximately 90% of the patients 10 . Regardless of the controversial satisfaction rate of conservative treatment, at least 5%–10% of patients who benefit little from conservative treatment were finally advised to undertake surgical interventions 11 …”

“…Similar as the open technique, arthroscopic extensor release and/or debridement also became a more and more popular and accepted technique for the management of TE with increasing number of literatures comparing the clinical outcome of open and arthroscopic approach. The advantages of the arthroscopic technique had been reported by various studies and reviews, including better visualization and assessment of the joint, a faster and earlier rehabilitation, lower complications rate, and patients' preference compared with open technique when both techniques can be indicated 11,22–25 . It seemed that the arthroscopic technique is a perfect replacement of conventional open technique whose application tuned more and more limited.…”

“…10 Regardless of the controversial satisfaction rate of conservative treatment, at least 5%-10% of patients who benefit little from conservative treatment were finally advised to undertake surgical interventions. 11 In the literature, several open techniques were proposed, including extensor release and/or debridement, extensor fasciotomy, denervation of the lateral epicondyle, epicondylar resection with anconeus muscle transfer, and the Garden procedure with lengthening of the ECRB. [11][12][13][14][15][16] Among them, extensor release and/or debridement which was originally described as "excision of diseased tissue at the origin of the ECRB tendon" 17 is one of the most well accepted techniques.…”

“…11 In the literature, several open techniques were proposed, including extensor release and/or debridement, extensor fasciotomy, denervation of the lateral epicondyle, epicondylar resection with anconeus muscle transfer, and the Garden procedure with lengthening of the ECRB. [11][12][13][14][15][16] Among them, extensor release and/or debridement which was originally described as "excision of diseased tissue at the origin of the ECRB tendon" 17 is one of the most well accepted techniques. Recently, arthroscopic treatment gained increasing popularity as a less invasive alternative of traditional open surgery.…”

“…In the literature, open and arthroscopic release/ debridement of TE were the most acknowledged techniques 11,13,14,16,22,30 for the management of TE, and some systematic reviews were published to compare the outcome of conventional open and arthroscopic surgery, 27,31,32…”