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Arthroscopic release and decortication provide earlier return to work with similar patient satisfaction compared to continued intensive conservative therapy for recalcitrant tennis elbow: a retrospective observational study

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Abstract

Introduction

Tennis elbow management has primarily been conservative over the years with over 90% of the cases being managed conservatively. Surgical intervention may be necessary only for symptomatic recalcitrant cases of tennis elbow cases. However, there are gaps in the literature when it comes to comparison of the return to pre-operative return to their work and level of activities among patients who undergo arthroscopic management and those who receive conservative management.

Methods

A retrospective observational study was conducted to compare 23 patients receiving continued intensive conservative (CIC) management in group 1 with 24 patients undergoing arthroscopic release of the extensor carpi radialis brevis and lateral epicondyle decortication (ARD) in group 2. The study had a minimum follow-up period of 3.5 years. The researchers compared the groups in terms of return to work (RTW) at the same intensity or lower level and any changes in their previous work. Objective grip strength and patient-reported outcome measures, such as post-intervention satisfaction level (rated on a scale of 0–100) and visual analog scale (VAS) for residual elbow pain, were also compared between the two groups.

Results

Return to work (RTW) occurred significantly earlier in group 2 (mean 6.13 months) compared to group 1 (mean 4.64 months), and a greater number of patients in group 2 (13/24, 54.2%) were able to return to the same of work. Although not statistically significant, the ARD group exhibited comparable patient satisfaction (p = 0.62) and visual analog scale (VAS) scores for residual elbow pain (p = 0.67). Grip strength was comparable (p = 0.084, 0.121) between the affected and unaffected sides of the bilateral upper extremities and among both groups of patients.

Conclusion

The use of ARD for RTE (recalcitrant tennis elbow) indicates a significantly earlier return to work (RTW) at the same or lower intensity level compared to the standard CIC therapy protocol. Objective grip strength was comparable to the non-affected side and among the two groups of patients receiving two different management modalities. Comparable patient-reported satisfaction and residual lateral elbow pain were also noted among both the groups.

Level of evidence

Retrospective, comparative study, level III.

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Data availability

The datasets used and/or analyzed during the current study may be available from the corresponding author on reasonable request. Data regarding this study are not available in any electronic databases.

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Acknowledgments

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Author notes

  1. Tarun Goyal

    Present address: Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, 249203, India

    Arghya Kundu Choudhury, Bishwa Bandhu Niraula, Shivam Bansal, Tushar Gupta & Tarun Goyal

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India

    Lakshmana Das

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  1. Arghya Kundu Choudhury
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Correspondence to Tarun Goyal.

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The institutional ethics committee approved the study (AIIMS/IEC/18/136). Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The study was conducted in All India Institute of Medical Sciences, Rishikesh, India. Ethics clearance for the study had been taken from the institutional ethics committee before starting the study.

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Choudhury, A.K., Niraula, B.B., Bansal, S. et al. Arthroscopic release and decortication provide earlier return to work with similar patient satisfaction compared to continued intensive conservative therapy for recalcitrant tennis elbow: a retrospective observational study. Eur J Orthop Surg Traumatol 34, 175–180 (2024). https://doi.org/10.1007/s00590-023-03628-5

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