Functional outcomes of arthroscopic treatment method of lateral epicondylitis

Abstract

Objective: The aim of this study is to evaluate the functional results of arthroscopic lateral epicondylitis (LE) treatment in patients in whom conservative treatment proved insufficient.
Methods: Between 2011–2014, 28 patients with LE (15 women, 14 men; mean age: 46 years; range: 33–79) who received at least 6 months of conservative treatment methods and did not achieve full recovery and thus underwent arthroscopic surgery were included in this study.
Results: One patient was excluded from the functional assessment. Mean follow-up was 20.5 months (range: 7–42). Mean preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores were 81.1±17.5 and 34.7±26.8 (p<0.0001), respectively, and Mayo Elbow Performance Scores (MEPS) were 48.5±11.5 and 101.2±22.9 (p<0.0001), respectively. Twenty-one patients (75%) were satisfied with the functional outcome.
Conclusion: As a result, LE treated with the arthroscopic method, with its low complication rate, successful degenerated tendon debridement, and decortication of the lateral epicondyle, is a useful method for intervention in pathologies such as annular plica, loose body, synovial hypertrophy, and radiocapitellar chondropathy.

 

Keywords

• Arthroscopy; elbow; lateral epicondylitis.

References

1. Walz DM, Newman JS, Konin GP, Ross G. Epicondyli- tis: pathogenesis, imaging, and treatment. Radiographics 2010;30:167–84.
2. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 2004;51:642–51.
3. Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling. J Musculoskelet Neuronal In- teract 2006;6:181–90.
4. Ihm J. Proximal wrist extensor tendinopathy. Curr Rev Musculoskelet Med 2008;1:48–52.
5. Cameron HU, Proctor M, Fornasier VL. Tennis elbow. Can Fam Physician 1983;29:2177–81.
6. Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med 2007;41:269–75.
7. Paungmali A, O’Leary S, Souvlis T, Vicenzino B. Hy- poalgesic and sympathoexcitatory effects of mobiliza- tion with movement for lateral epicondylalgia. Phys Ther 2003;83:374–83.
8. Finestone HM, Rabinovitch DL. Tennis elbow no more: practical eccentric and concentric exercises to heal the pain. Can Fam Physician 2008;54:1115–6.

9. Viswas R, Ramachandran R, Korde Anantkumar P. Com- parison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. ScientificWorld- Journal 2012;2012:939645.
10. Crowther MA, Bannister GC, Huma H, Rooker GD. A prospective, randomised study to compare extracorporeal shock-wave therapy and injection of steroid for the treat- ment of tennis elbow. J Bone Joint Surg Br 2002;84:678–9.
11. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a re- view. Curr Rev Musculoskelet Med 2008;1:165–74.
12. Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection thera- pies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med 2009;43:471–81.
13. Suresh SP, Ali KE, Jones H, Connell DA. Medial epicon- dylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med 2006;40:935–9.
14. Espandar R, Heidari P, Rasouli MR, Saadat S, Farzan M, Rostami M, et al. Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial. CMAJ 2010;182:768–73.
15. Petrella RJ, Cogliano A, Decaria J, Mohamed N, Lee R. Management of Tennis Elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol 2010;2:4.
16. Ahmad Z, Wardale J, Brooks R, Henson F, Noorani A, Rushton N. Exploring the application of stem cells in ten- don repair and regeneration. Arthroscopy 2012;28:1018– 29.
17. Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br 2004;86:701–4.
18. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ, et al. Mini-open muscle resection procedure under local anesthesia for lateral and medial epicondylitis. Clin Or- thop Surg 2009;1:123-7.
19. Calvert PT, Allum RL, Macpherson IS, Bentley G. Simple lateral release in treatment of tennis elbow. J R Soc Med 1985;78:912–5.
20. Işikan UE, Sarban S, Kocabey Y. The results of open sur- gical treatment in patients with chronic refractory lateral epicondylitis. [Article in Turkish] Acta Orthop Traumatol Turc 2005;39:128,32.
21. Siddiqui MA, Koh J, Kua J, Cheung T, Chang P. Func- tional outcome assessment after open tennis elbow re- lease: what are the predictor parameters? Singapore Med J 2011;52:73–6.
22. Rayan F, Rao V Sr, Purushothamdas S, Mukundan C, Shafqat SO. Common extensor origin release in recalci- trant lateral epicondylitis - role justified? J Orthop Surg Res 2010;5:31.
23. Solheim E, Hegna J, Øyen J. Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows. Knee Surg Sports Traumatol Arthrosc 2011;19:1023–7.
24. Baker CL Jr, Murphy KP, Gottlob CA, Curd DT. Ar- throscopic classification and treatment of lateral epicon- dylitis: two-year clinical results. J Shoulder Elbow Surg 2000;9:475–82.
25. Akpinar S, Hersekli MA, Demirors H, Tandogan RN. Ar- throscopic Release of The LE (A Case Report) Joint Dis- eases & Related Surgery 2001;12:87–90.
26. http://www.orthopaedicscore.com/scorepages/mayo_el- bow.html.
27. http://www.drsedatyildiz.com/FileUpload/ks109487/ File/quickdash_turkey.pdf.
28. Smith AM, Castle JA, Ruch DS. Arthroscopic resection of the common extensor origin: anatomic considerations. J Shoulder Elbow Surg 2003;12:375–9.
29. Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg 2014;23:1527–31.
30. Organ SW, Nirschl RP, Kraushaar BS, Guidi EJ. Sal- vage surgery for lateral tennis elbow. Am J Sports Med 1997;25:746–50.
31. Owens BD, Murphy KP, Kuklo TR. Arthroscopic release for lateral epicondylitis. Arthroscopy 2001;17:582–7.
32. Newman JH, Goodfellow JW. Fibrillation of head of radi- us as one cause of tennis elbow. Br Med J 1975;2:328–30.
33. Tanaka Y, Aoki M, Izumi T, Wada T, Fujimiya M, Ya- mashita T. Effect of elbow and forearm position on contact pressure between the extensor origin and the lateral side of the capitellum. J Hand Surg Am 2011;36:81–8.
34. Rajeev A, Pooley J. Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg 2009;75:37–40.
35. Sasaki K, Onda K, Ohki G, Sonoda T, Yamashita T, Wada T. Radiocapitellar cartilage injuries associated with tennis elbow syndrome. J Hand Surg Am 2012;37:748–54.
36. Szabo SJ, Savoie FH 3rd, Field LD, Ramsey JR, Hose- mann CD. Tendinosis of the extensor carpi radialis brevis: an evaluation of three methods of operative treatment. J Shoulder Elbow Surg 2006;15:721–7.
37. Yan H, Cui GQ, Liu YL, Xiao J, Yang YP, Ao YF. A ran- domized comparison of open and arthroscopic Nirschl debridement for refractory lateral epicondylitis. [Article in Chinese] Zhonghua Wai Ke Za Zhi 2009;47:888–91. [Abstract]
38. Solheim E, Hegna J, Øyen J. Arthroscopic versus open ten- nis elbow release: 3- to 6-year results of a case-control se- ries of 305 elbows. Arthroscopy 2013;29:854–9.
39. Othman AM. Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow. Arch Orthop Trauma Surg 2011;131:383–8.
40. Kim JW, Chun CH, Shim DM, Kim TK, Kweon SH, Kang HJ, et al. Arthroscopic treatment of lateral epicon- dylitis: comparison of the outcome of ECRB release with and without decortication. Knee Surg Sports Traumatol Arthrosc 2011;19:1178–83.
41. Zingg PO, Schneeberger AG. Debridement of extensors and drilling of the lateral epicondyle for tennis elbow: a retrospective follow-up study. J Shoulder Elbow Surg 2006;15:347–50.
42. Kelly EW, Morrey BF, O’Driscoll SW. Complications of el- bow arthroscopy. J Bone Joint Surg Am 2001;83–A:25–34.