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Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear.

Questions/purposes

We asked if posterior radiocapitellar synovial plica excision made any additional improvement in pain or function after arthroscopic ECRB release.

Methods

We retrospectively reviewed 38 patients who had arthroscopic treatment for refractory lateral epicondylitis between November 2003 and October 2009. Twenty patients (Group A) underwent the Baker technique and 18 patients (Group B) underwent a combination of the Baker technique and posterior synovial plica excision. The minimum followup was 36 months (mean, 46 months; range, 36–72 months) for Group A and 25 months (mean, 30 months; range, 25–36 months) for Group B. Postoperatively we obtained VAS pain and DASH scores for each group.

Results

Two years postoperatively, we found no differences in the VAS pain score or DASH: the mean VAS pain scores were 0.3 points in Group A and 0.4 points in Group B, and the DASH scores were 5.1 points and 6.1 points respectively.

Conclusions

The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication.

Level of Evidence

Level III, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.

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Acknowledgments

We thank Byoung Won Ko MD for clinical evaluation and critical review.

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Authors and Affiliations

  1. Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianity Hospital, Pohang, Kyeongbuk, Korea

    In Hyeok Rhyou MD & Kang Wook Kim MD

Authors
  1. In Hyeok Rhyou MD
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  2. Kang Wook Kim MD
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Correspondence to Kang Wook Kim MD.

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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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Rhyou, I.H., Kim, K.W. Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?. Clin Orthop Relat Res 471, 284–290 (2013). https://doi.org/10.1007/s11999-012-2585-z

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