Abstract
BackgroundTennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. Most cases resolve within 2 years of symptom onset, but a subset of patients will develop persistent symptoms despite appropriate conservative management. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. This procedure involves the arthroscopic release of the extensor carpi radialis brevis tendon (ECRB) origin at the elbow. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. However, in order to justify its widespread use and growing popularity, a high level of evidence study is required. The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis.MethodsWe will conduct a prospective single center, double-blind, randomized sham-controlled parallel arm trial evaluating the efficacy of arthroscopic tennis elbow release in adult patients with symptoms for at least 6 months. Patients will undergo intraoperative randomization after diagnostic arthroscopy of the elbow to receive either ECRB release (through the creation of a lateral portal) or a sham lateral portal and no ECRB release. The primary outcome will be the Mayo Elbow Performance Score (MEPS) at 1 year follow-up. Secondary outcomes will be the abbreviated Disability of the Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons elbow (ASES-e) score and grip strength at 3, 6, 12 and 24 months as well as return-to-work time, ability to return to full duty and adverse outcomes.DiscussionResults of this study will provide empirical high quality evidence to guide clinical decision-making in patients with chronic tennis elbow.Trial registrationNCT02236689 (September 8, 2014)
Highlights
Tennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability
This study aims to elicit whether arthroscopic tennis elbow release (ATER) is efficacious at treating chronic tennis elbow
Participants are subjected to the possibility of suffering an adverse event and our proposed trial is no different. It is imperative from an ethical point of view to answer the following questions: 1) is the question worth asking, 2) is there an alternative, less risky approach that adequately answers the question, and 3) are the risks justified by the expected benefits of answering the question? The first point was previously addressed in our discussion about the rate of affliction of tennis elbow and the lack of evidence to support the efficacy of a commonly performed orthopaedic procedure aimed at treating it
Summary
Tennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. In order to justify its widespread use and growing popularity, a high level of evidence study is required The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis. Some studies report a full recovery rate as low as 34 % by 12 months [12]
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