Comparative study of functional outcomes of open versus arthroscopic surgery of lateral epicondylitis in a tertiary care hospital

Authors

  • Bishal Kundu Calcutta National Medical College
  • Debangshu Kumar Calcutta National Medical College

DOI:

https://doi.org/10.18203/2349-2902.isj20223162

Keywords:

Lateral epicondylitis, Tennis Elbow, Arthroscopy elbow, Extensor carpi radialis brevis, Nirschl procedure

Abstract

Background: Lateral epicondylitis, a degenerative tendinopathy due to microtears in extensor tendons caused by repeated pronation-supination is commonly managed by NSAIDS, physiotherapy, local steroid injections and braces. Although most are self limited, some recalcitrant cases lead to chronic pain and reduction in quality of life. Surgical management by open or arthroscopic means is a viable option but there is a gap of knowledge in current literature regarding superiority of one over the other.

Methods: A total of 32 patients with recalcitrant lateral epicondylitis admitted from March 2019 to August 2020 were enrolled and randomized into two groups, receiving either open or arthroscopic debridement of diseased tendons of extensor carpi radialis longus, brevis and communis. Patients were assessed for pain, functional outcome and complications with a 6 month follow-up.

Results: VAS score for pain and DASH score for functional outcome improved in all patients after surgery and there was no difference between the two groups. Although mean duration of surgery was significantly longer by arthroscopy, time to return to work was significantly shorter in this group (p<0.001). Difference in complication rate was not statistically significant.

Conclusions: Based on this study, surgical management both open and arthroscopic are equally effective for recalcitrant lateral epicondylitis in terms of pain, functional score and patient satisfaction; arthroscopy however shows an earlier return to work. Either can be chosen depending on available skill, equipment and patient demands.

Author Biographies

Bishal Kundu, Calcutta National Medical College

Senior Resident, Department of Orthopaedics

Debangshu Kumar, Calcutta National Medical College

Senior Resident and Emergency Surgeon, Department of Orthopaedics, Calcutta National Medical College and Hospital

References

Nirschl RP, Pettrone FA. Tennis elbow: The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61:832-9.

Nirschl RP, Ashman ES. Elbow tendinopathy: Tennis elbow. Clin Sports Med. 2003:22(4):813-36.

De Smedt, de Jong, Van Leemput. Lateral epicondylitis in Tennis: Update on aetiology, biomechanics and treatment. Br J Sports Med. 2007;41:816-9.

Monto R. Tennis elbow repair with or without suture anchors: A randomized clinical trial. Techn Shoulder Elbow Surg. 2014;15(3):92-7.

Altay T, Gunal I, Ozturk H. Local injection treatment for lateral epicondylitis. Clin Orthop Rel Res. 2002;398:127-30.

Sanders TL, Kremers HM, Bryan AJ, Ransom JE. The Epidemiology & Health Care Burden of Tennis Elbow. Am J Sports Med. 2015;43(5):1066-71.

Clark T, McRae S, Zhang Y, Dubberley J. Arthroscopic versus Open Lateral Release for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Trial. Arthroscopy. 2018;34(12):3177-84.

Wang W, Chen J, Lou J, Shentu J. Comparison of Arthroscopic Debridement and Open Debridement in the Management of Lateral Epicondylitis. Medicine. 2019;98(44):e17668.

Riff AJ, Saltzman BM, Cvetanovich G. Open vs Percutaneous vs Arthroscopic Surgical Treatment of Lateral Epicondylitis: An Updated Systematic Review. Am J Orthrop. 2018;47(6):43.

Moradi A, Pasdar P, Mehrad-Majd H, Ebrahimzadeh MH. Clinical Outcomes of Open versus Arthroscopic Surgery for Lateral Epicondylitis, Evidence from a Systematic Review. Arch Bone Joint Surg. 2019;7(2):91-104.

Szabo SJ, Savoie FH, Field LD, Ramsey JR. Tendinosis of Extensor Carpi Radialis Brevis: an Evaluation of Three Methods of Operative Treatment. J Shoulder Elbow Surg. 2006;15(6):721-7.

Greco S, Nellans KW, Levine WN. Lateral Epicondylitis: Open versus Arthroscopic. Oper Tech Orthop. 2009;19(4):228-34.

Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic Lateral Epicondylitis: Challenges and Solutions. Open Access J Sports Medic. 2018;9:243-51.

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Published

2022-11-28

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Section

Original Research Articles