Refrakter lateral epikondilitte perkütan tenotomi, kortikosteroid enjeksiyonu ve şok dalga tedavisinin zaman bağımlı karşılaştırmalı etkinliği

Abstract

Giriş: Lateral epikondilit, erişkinlerde sık görülen bir dirsek ağrısı nedenidir; ancak yaygın olarak uygulanan tedavi yöntemlerinin uzun dönem etkinliği tam olarak net değildir. Kortikosteroid enjeksiyonları hızlı ancak kısa süreli bir rahatlama sağlarken, perkütan iğne tenotomisi ve ekstrakorporeal şok dalga tedavisi (ESWT) daha kalıcı sonuçlar sunabilir. Bu çalışma, bu üç tedavi yönteminin karşılaştırılmasını ve 12 aylık takipte hasta tarafından kabul edilebilir semptom durumu (PASS) eşik değerlerinin belirlenmesini amaçlamıştır. Yöntemler: Retrospektif karşılaştırmalı kohort çalışması, tek bir üçüncü basamak merkezde, konservatif tedavinin ≥3 ay başarısız olmasının ardından üç farklı müdahaleden birini alan 107 refrakter lateral epikondilit hastasını içermektedir: kortikosteroid enjeksiyonu (n = 43), ESWT (n = 36) veya perkütan tenotomi (n = 28). Ağrı ve fonksiyon düzeyi başlangıçta ve 1., 3., 6. ve 12. aylarda Görsel Analog Skala (VAS) ve Mayo Elbow Performance Score (MEPS) kullanılarak değerlendirildi. 12. ayda Global Rating of Change (GROC) skorları PASS eşik değerlerini belirlemek için ROC analizi ile değerlendirildi. Bulgular: Kortikosteroid enjeksiyonu, 1. ayda en hızlı iyileşmeyi sağladı (VAS 2,9 ± 1,2; MEPS 80,5 ± 7,9), ancak bu etki zamanla azaldı. Tenotomi, 12. ayda en belirgin ağrı ve fonksiyonel iyileşmeyi gösterdi (VAS 4,3 ± 1,2; MEPS 79,3 ± 9,3; p < 0,001). ESWT (VAS 5,2 ± 1,3; MEPS 69,7 ± 10,3) orta düzeyde ve kalıcı etki sağlarken, kortikosteroid enjeksiyonu en düşük uzun dönem etkinliği gösterdi (VAS 7,2 ± 1,0; MEPS 56,0 ± 10,0). ROC analizi, klinik olarak anlamlı PASS eşiklerini VAS ≤ 5,5 ve MEPS ≥ 70,5 olarak belirledi (AUC: 0,890 ve 0,917). Sonuç: Bu üç kollu karşılaştırmalı çalışma, tedavi yanıtında belirgin bir zaman bağımlı etkinlik ortaya koymuştur: Kortikosteroid enjeksiyonu hızlı ancak kısa süreli bir rahatlama sağlarken, ESWT orta düzeyde ve kalıcı sonuçlar sunmakta, tenotomi ise 12. ayda en iyi sonuçları vermektedir. PASS eşik değerlerinin klinik karar süreçlerine entegre edilmesi, refrakter lateral epikondilit tedavisinde hasta merkezli, pragmatik bir yaklaşım sağlamaktadır.

Keywords

• Lateral epikondilit
• perkütan tenotomi
• kortikosteroid enjeksiyonu
• ekstrakorporeal şok dalga tedavisi
• hasta tarafından kabul edilebilir semptom durumu
• karşılaştırmalı etkinlik.

Time-dependent comparative effectiveness of percutaneous tenotomy, corticosteroid injection, and shockwave therapy in refractory lateral epicondylitis

Abstract

Aims: Lateral epicondylitis (LE) is a frequent cause of elbow pain in adults, yet the long-term effectiveness of commonly used interventions remains unclear. Corticosteroid injections offer rapid but short-lived relief, while percutaneous needle tenotomy and extracorporeal shockwave therapy (ESWT) may provide more durable outcomes. This study aimed to compare these three modalities and define patient-acceptable symptom state (PASS) thresholds over 12 months. Methods: A retrospective comparative cohort study was conducted at a single tertiary center including 107 patients with refractory LE who received one of three interventions after ≥3 months of failed conservative treatment: corticosteroid injection (n=43), ESWT (n=36), or percutaneous tenotomy (n=28). Pain and function were evaluated at baseline and 1, 3, 6, and 12 months using the Visual Analog Scale (VAS) and Mayo Elbow Performance Score (MEPS). Global Rating of Change (GROC) was assessed at 12 months to derive ROC-based PASS thresholds. Results: Corticosteroid injection provided the most rapid early improvement at 1 month (VAS 2.9±1.2; MEPS 80.5±7.9), but these benefits declined over time. Tenotomy demonstrated the greatest functional and pain improvement at 12 months (VAS 4.3±1.2; MEPS 79.3±9.3; p<0.001), followed by ESWT (VAS 5.2±1.3; MEPS 69.7±10.3), while corticosteroid injection showed the least durable effect (VAS 7.2±1.0; MEPS 56.0±10.0). ROC analyses identified clinically meaningful PASS thresholds of VAS≤5.5 and MEPS≥70.5, with AUC values of 0.890 and 0.917, respectively. Conclusion: This three-arm comparative study highlights a clear temporal hierarchy in treatment response: corticosteroid injection yields fast but short-term relief, ESWT provides sustained intermediate outcomes, and percutaneous tenotomy offers the most durable improvements at 12 months. Incorporating PASS-based thresholds provides a pragmatic, patient-centered framework for clinical decision-making in refractory LE.

Keywords

• Lateral epicondylitis
• percutaneous tenotomy
• corticosteroid injection
• extracorporeal shockwave therapy
• patient acceptable symptom state
• comparative effectiveness

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