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Arthroscopic lateral epicondylitis release using the "bayonet" technique.

ABSTRACT: Most patients diagnosed with lateral epicondylitis respond well to conservative management. For patients who do not respond to nonoperative modalities, surgical treatment represents a viable option for long-term symptomatic relief. The arthroscopic surgical technique described in this article has been consistently used by the senior author for the treatment of recalcitrant lateral epicondylitis for more than 5 years (198 patients) without the occurrence of any major complications and appears to be a safe, reliable, and efficacious surgical intervention for the management of lateral epicondylitis.

SUBMITTER: Stiefel EC

PROVIDER: S-EPMC3986618 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Arthroscopic lateral epicondylitis release using the "bayonet" technique.

Stiefel Eric C EC Field Larry D LD

Arthroscopy techniques 20140131 1

Most patients diagnosed with lateral epicondylitis respond well to conservative management. For patients who do not respond to nonoperative modalities, surgical treatment represents a viable option for long-term symptomatic relief. The arthroscopic surgical technique described in this article has been consistently used by the senior author for the treatment of recalcitrant lateral epicondylitis for more than 5 years (198 patients) without the occurrence of any major complications and appears to ...[more]

PMID: 24749034

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Project description:PurposeTo compare the short-term outcomes between arthroscopic and open procedures for the treatment of lateral epicondylitis. Because a significant portion of patients have worker's compensation (WC), the outcomes in these subgroups were separately analyzed.MethodsA retrospective analysis of patients who had surgical treatment of lateral epicondylitis by a single surgeon from 2010 to 2017 was performed. Patients who were symptomatic after 9 months of conservative treatments including nonsteroidal medications, steroid injections, and physical therapy were offered surgical intervention. The type of surgery was selected after detailed consultation with the patient. Charts were reviewed for preoperative pain, grip strength as measured by dynamometer, smoking status, and WC status. Postoperative assessments included pain and grip strength at 6 weeks and time taken to return to full duty. Two groups were compared using unpaired t test and chi-squared tests. Results were compared with similar studies in the literature.ResultsThe study included 30 patients in the arthroscopic debridement group and 42 patients in the open tenotomy and reinsertion group. Eighteen patients (25%) had WC. Compared with the open group, the arthroscopic group had earlier return to full duty (mean 7.13 weeks, confidence interval [CI] 6.21 to 8.05 versu mean of 12.22 weeks, CI 11.21 to 13.24; P < .001) and less time for complete pain relief (mean 7.4 weeks, CI 7.02 to 7.93 versus 9.5 , CI 8.68 to 10.44; P = .043). No difference was seen among the groups in terms of unfavorable outcome (persistent pain and recurrence of pain), JAMAR hand dynamometer score at 6 weeks, and visual analog score at 6 weeks. A total of 11 patients (15%) had unfavorable outcome. Incidence of unfavorable outcomes was more in patients with WC insurance (36% in WC versus 7% in non-WC; P = .023). No association was seen with smoking status. WC patients also had a longer time to return to full duty (16.68 weeks for WC versus 7.65 weeks for non-WC; P < .001) and a longer time to get complete pain relief (12.4 weeks for WC versus 7.5 weeks for non-WC; P < .001).ConclusionThe arthroscopic technique offers advantages of earlier return to work and shorter recovery period along with additional advantages of joint inspection and ability to treat coexisting pathologies. WC patients had a longer time to return to full duty and time for complete pain relief.Level of evidenceLevel III, retrospective comparative study.

Project description: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).

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Arthroscopic lateral epicondylitis release using the "bayonet" technique.

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Arthroscopic lateral epicondylitis release using the "bayonet" technique.

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