Arthroscopic Tennis Elbow Release: Outcomes Correlated to Associated Lesions (SS-50)

Abstract

Pain relief and strength, after arthroscopic tennis elbow release, continue to improve for the first 12 months, with little improvement thereafter. Description of and Prospective analysis of long-term outcomes of arthroscopic tennis elbow release. 100 patients (102 elbows) with lateral epicondylitis, recalcitrant to a minimum of 6 months of supervised conservative management, underwent arthroscopic lateral epicondylar release. Each patient was clinically evaluated pre-operatively and post-operatively and a quantitative assessment of the grip strength was collected on both sides with a dynamo meter, in full elbow extension and in 90 degrees flexion. Functional assessment with the Mayo Elbow Performance Score and dynamo meter grip strengths were collected for the first two years post-operation. Postoperative follow-up averaged 36 months (range 24-45months). The average MEPS increased from 57/100 to 89/100. 98 elbows were graded as excellent/good outcomes, and 4 elbows were noted to have fair outcomes. The latter 4 patients were assessed to have type 2 failure, with two subsequently requiring PIN releases, one requiring an osteochondroma excision from the distal lateral humerus, and one patient lost to follow-up. Dynamo meter strength returned to above pre-operative level at an average of 3 months and were and average of 35% greater than the pre-operative level at final review. Complications consisted of synovial fistulae (n=8) all of which spontaneously resolved within one month, 2 portal superficial infections, 1 mild anterior capsular contracture, and no neurovascular injuries. Concurrent intra-articular pathology that was noted included radio-capitellar chondrosis (n=42), lateral trochlear chondrosis (n=30), anterolateral synovial plicae (n=17), synovitis (n=23), radial head instability (n=6), and synovial osteochondromatosis (n=1). A trend of decreased subjective satisfaction was observed when correlated to the number of associated lesions. Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. The results show that pain relief and strength improve significantly upto 3 months post-surgery, and continue to improve for the first 12 months, with little improvement beyond that time. Associated lesions may have a negative effect on subjective outcomes.