Medium-Term Results After Treatment of Recalcitrant Lateral Epicondylitis

Abstract

Background:Recalcitrant lateral epicondylitis (elbow extensor–origin tendinosis) is a common cause of elbow pain with many treatment options. In the present study, the medium-term results after open release and radiofrequency microtenotomy are reported.Hypothesis:Microtenotomy would provide long-term pain relief that was as good as the open release method.Study Design:Prospective, randomized trial.Methods:Twenty-four patients randomized to either open release or microtenotomy were assessed after 5 to 7 years. Clinical examination and dynamic infrared thermography (DIRT) of both elbows were performed preoperatively and at the medium-term follow-up. Magnetic resonance imaging (MRI) of both elbows was performed at the medium-term follow-up.Results:Significant pain reduction was found using a visual analog scale (VAS) at the medium-term follow-up in both groups compared with the preoperative assessment (P < .005). The Mayo Elbow Performance Score (MEPS) increased significantly in both groups (P < .01). The improvement in grip strength was not significant in either group. There was no significant difference between the groups in terms of VAS, strength, and the MEPS. On the DIRT examinations, there were significantly fewer hot spots at the medium-term follow-up than preoperatively (P = .0067, both study groups together). The MRI examinations revealed grade II changes in the operated elbow in 1 patient in each group at the medium-term follow-up, while all the other MRI examinations revealed a normal tendon.Conclusion:In this prospective, randomized trial with a medium-term follow-up, the results were similar after surgical release and microtenotomy in patients with recalcitrant lateral epicondylitis. The hypothesis was thus verified.

Percutaneous microtenotomy using a microdebrider coblation wand for the treatment of lateral epicondylitis: A systematic review

“…The 9 articles represented only 8 studies because outcomes from 1 study were published for 2 different follow-up time periods in 2 separate papers. [16,17]…”

“…Five studies measured grip strength, out of which 4 were randomized controlled trials. [13,15–17] All 5 reported an improvement in grip strength. [12,15–17,19] Two studies observed an increase in grip strength, but was either not significant or they did not provide statistical analysis.…”

“…[7,11] Recent studies have expressed concern about the invasive nature of the open and arthroscopic tenotomy techniques and proven that a percutaneous microtenotomy procedure is an effective treatment option for lateral epicondylitis given that the procedure can be performed under live ultrasound guidance without having to dissect the soft tissue down to the tendon. [12–20]…”

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

“…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…”