Abstract
Purpose
Controversy exists with regards to the etiology and treatment of lateral epicondylitis and the role of the lateral capsule in this pathology. The aim of this study was to compare arthroscopic lateral capsule resection with or without extensor carpi radialis brevis (ECRB) tendon debridement for treatment of lateral epicondylitis.
Methods
This is a retrospective study of 38 patients who underwent arthroscopic surgery for LE with two different techniques: Eighteen patients were treated with arthroscopic lateral capsular resection (LCR) + ECRB debridement and 20 patients were treated with arthroscopic LCR alone, without ECRB debridement. Both groups were assessed with Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score for function and Visual Analog Scale (VAS) score for pain.
Results
Quick DASH scores were 12 \(\pm \) 5 and 13 \(\pm \) 4 at Groups 1 and 2, respectively, without any statistically significant difference. VAS pain scores were 15 \(\pm \) 2 for both groups. VAS function scores were 85 \(\pm \) 22 and 86 \(\pm \) 18 at Groups 1 and 2 respectively. Sick leave periods in terms of weeks were 7 \(\pm \) 5 and 7 \(\pm \) 4 at Groups 1 and 2, respectively. There was no statistically significant difference in outcome of the two groups compared in terms of VAS pain, function scores, failure (re-operation) rates and sick leave period at the end of final follow-up.
Conclusion
Both arthroscopic LCR alone and Arthroscopic LCR with ECRB debridement for the management of refractory LE provide significant improvement in pain and function. Isolated Arthroscopic LCR could be a sufficient surgical treatment for refractory LE. Thus, ECRB debridement or release may not be necessary in every case.
Level of evidence
IV.
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References
Ahmad Z, Siddiqui N, Malik S, Abdus-Samee M, Tytherleigh-Strong G, Rushton N (2013) Lateral epicondylitis: a review of pathology and management. Bone Joint J 95:1158–1164
Antuna SA, O’Driscoll SW (2001) Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy 17:491–495
Babaqi AA, Kotb MM, Said HG, AbdelHamid MM, ElKady HA, ElAssal MA (2014) Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex. J Orthop 11:82–86
Baker CL Jr (2000) Arthroscopic versus open techniques for extensor tendinosis of the elbow. Tech Shoulder Elbow Surg 1:184–191
Baker CL Jr, Murphy KP, Gottlob CA, Curd DT (2000) Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results. J Shoulder Elbow Surg 9:475–482
Beaton DE, Wright JG, Katz JN, Group UEC (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 87:1038–1046
Benjamin M, Toumi H, Ralphs J, Bydder G, Best T, Milz S (2006) Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 208:471–490
Bosworth DM (1955) The role of the orbicular ligament in tennis elbow. J Bone Joint Surg Am 37:527–533
Buchbinder R, Johnston RV, Barnsley L, Assendelft WJ, Bell SN, Smidt N (2011) Surgery for lateral elbow pain. Cochrane Database Syst. Rev. 16(3):CD003525
Budoff JE, Hicks JM, Ayala G, Kraushaar BS (2008) The reliability of the “Scratch test”. J Hand Surg [Br] 33:166–169
Burke NG, Mullett H (2011) Arthroscopic tennis elbow release. Ann R Coll Surg Engl 93:435–436
Coonrad RW, hooper WR, (1973) Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am 55:1177–1182
Duparc F, Putz R, Michot C, Muller J-M, Freger P (2002) The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow. Surg Radiol Anat 24:302–307
Grewal R, MacDermid JC, Shah P, King GJ (2009) Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. J Hand Surg [Am] 34:849–857
Karkhanis S, Frost A, Maffulli N (2008) Operative management of tennis elbow: a quantitative review. Br Med Bull 88:171–188
Lattermann C, Romeo AA, Anbari A, Meininger AK, McCarty LP, Cole BJ et al (2010) Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg 19:651–656
Longacre MD, Baker CL III, Baker CL Jr (2014) Arthroscopic management of lateral epicondylitis. Oper Tech Sports Med 22:142–147
Mullett H, Brown G, Hausman M (2005) Arthroscopic treatment of lateral epicondylitis: clinical and cadaveric studies. Clin Orthop 439:123–128
Nirschl RP, Pettrone F, Tennis elbow, (1979) The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 61:832–839
Othman AMA (2011) Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow. Arch Orthop Trauma Surg 131:383–388
Owens BD, Murphy KP, Kuklo TR (2001) Arthroscopic release for lateral epicondylitis. Arthroscopy 17:582–587
Peart RE, Strickler SS, Schweitzer JK (2004) Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop 33:565–567
Sevier TL, Wilson JK (1999) Treating lateral epicondylitis. Sports Med 28:375–380
Smith-Forbes EV, Howell DM, Willoughby J, Pitts DG, Uhl TL (2018) A Retrospective Cohort Study of QuickDASH Scores for Three Hand Therapy Acute Upper Limb Conditions. Mil Med 183:522–529
Solheim E, Hegna J, Øyen J (2011) Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows. Knee Surg Sports Traumatol Arthrosc 19:1023–1027
Solheim E, Hegna J, Øyen J (2013) Arthroscopic versus open tennis elbow release: 3-to 6-year results of a case-control series of 305 elbows. Arthroscopy 29:854–859
Stapleton T, Baker C (1996) Arthroscopic treatment of lateral epicondylitis: a clinical study. Arthroscopy 12:365–366
Svernlöv B, Adolfsson L (2006) Outcome of release of the lateral extensor muscle origin for epicondylitis. Scand J Plast Reconstr Surg Hand Surg 40:161–165
Szabo SJ, Savoie FH III, Field LD, Ramsey JR, Hosemann CD (2006) Tendinosis of the extensor carpi radialis brevis: an evaluation of three methods of operative treatment. J Shoulder Elbow Surg 15:721–727
Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier MC (2004) Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil 85:308–318
Yeoh KM, King GJ, Faber KJ, Glazebrook MA, Athwal GS (2012) Evidence-based indications for elbow arthroscopy. Arthroscopy 28:272–282
Yoon JP, Chung SW, Yi JH, Lee B-J, Jeon I-H, Jeong W-J et al (2015) Prognostic factors of arthroscopic extensor carpi radialis brevis release for lateral epicondylitis. Arthroscopy 31:1232–1237
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Paksoy, A.E., Laver, L., Tok, O. et al. Arthroscopic lateral capsule resection is enough for the management of lateral epicondylitis. Knee Surg Sports Traumatol Arthrosc 29, 2000–2005 (2021). https://doi.org/10.1007/s00167-020-06255-3
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DOI: https://doi.org/10.1007/s00167-020-06255-3