The result of surgical treatment of medial epicondylitis: analysis with more than a 5-year follow-up

Han, Soo-Hong; Lee, Jun-Ku; Kim, Hyeong-Jong; Lee, Soo-Hyun; Kim, Ji-Woong; Kim, Tae-Seob

doi:10.1016/j.jse.2016.05.010

Cited by 20 publications

(38 citation statements)

References 14 publications

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“…However, our case study is comparable in size with those previously published on the topic. 6,[11][12][13]24,28 Fourth, we note that PRP injections are frequently an out-of-pocket expense, and thus, treatment groups were self-selected by the patient. This may have created unintended selection bias regarding which patients received PRP injections versus surgery.…”

Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis

Bohlen

Schwartz

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management. Purpose: To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery. Study Design: Cohort study; Level of evidence, 3. Methods: To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity. Results: The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively ( P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores. Conclusion: In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.

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Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis

Bohlen

Schwartz

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Second, it may have aided in our treatment of ulnar neuritis. Han et al 14 were able to demonstrate equivalent success in treating patients with and without ulnar neuritis with a technique that incorporated a medial epicondylectomy. Traditionally, medial epicondylectomy was recommended only in the presence of abnormal nerve conduct studies (NCS).…”

Section: Discussionmentioning

confidence: 99%

“…Kurvers and Verhaar 15 reported that 69% (11/16) of elbows with isolated ME were symptom-free, while only 13% (3/24) of elbows that had concomitant ulnar neuritis were symptom-free. As discussed, more recent studies 13,14,24,29 have questioned the relationship between preoperative ulnar neuritis and poorer outcomes. Similarly, in our case series, we found no difference in outcomes when using our technique in elbows with (94% successful) or without (93% successful) ulnar neuritis.…”

Section: Discussionmentioning

confidence: 99%

“…22 Published reports of operative intervention report successful outcomes in 63% to 97% of cases, with a wide range of surgical techniques described. Previously described techniques have included simple debridement of the tendon or medial epicondyle with 5,14 or without 15,24,30 microfracture, release of the tendon either open16 or percutaneously, 2,3 or release and repair of the tendon via suture fixation 10,22,28 or suture anchor constructs. 13,29 Unique procedures have also been described with good results utilizing coblation therapy 26 in addition to a reported Z-lengthening procedure where a Z-shaped musculofascial lengthening is made in the FPO muscle-tendon origin.…”

mentioning

confidence: 99%

“…Type II patients were characterized by the presence of clinical signs and symptoms of ulnar neuritis, an association reported in up to 60% of ME patients. 10,[13][14][15]22,24,29 Traditionally, the presence of preoperative ulnar neuritis has been associated with worse surgical outcomes, leading to overall success rates as low as 63%. 10,15 Nonoperative treatment is a mainstay in the initial management of ME, with symptoms resolving in up to 90% of cases.…”

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confidence: 99%

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Double-Row Repair for Recalcitrant Medial Epicondylitis

Thon

Finley

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective.Purpose:To evaluate the clinical outcomes of a double-row repair for ME.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system.Results:The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively (P < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively (P = .67).Conclusion:A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.

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Medial and Lateral Epicondylitis

McCarron

Kafrouni²

2022

The Resident's Guide to Shoulder and Elbow Surgery

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The result of surgical treatment of medial epicondylitis: analysis with more than a 5-year follow-up

Cited by 20 publications

References 14 publications

Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis

Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis

Double-Row Repair for Recalcitrant Medial Epicondylitis

Medial and Lateral Epicondylitis

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