Arthroscopic Versus Open Lateral Release for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Trial

Abstract

The purpose was to determine if quality of life and function are different following arthroscopic versus open tennis elbow release surgery. Seventy-five patients were recruited with confirmed lateral epicondylitis with a minimum of 6 months failed conservative treatment, at least one corticosteroid injection, and negative x-ray for fracture. Patients were randomized intraoperatively to undergo either arthroscopic or open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength evaluated at pre-, and 6-week, 3-, 6-, and 12-months post-surgery. Significance was p<0.05. Thirty-seven patients (18 women, 19 men) underwent the open procedure with a mean age of 46.9 (7.04) years and 38 patients (16 women, 22 men) were in the arthroscopic group with a mean age of 45.6 (6.8). No pre-surgery differences were found between groups based on age, sex, DASH or VAS scores. The arthroscopic approach had a significantly longer surgery time than open, 34:00 vs 22:30 minutes (p=0.005). Both groups demonstrated a significant improvement in subjective measures (DASH and VAS) and grip strength by 12-months post-surgery, and no significant differences were found between groups at any time point. There was an interaction effect between DASH score at 12-months and WCB status with non-WCB patients in the Open group scoring lower (did better) on the DASH than the Arthroscopic group and the Arthroscopic group scoring lower in the Open group. Age, gender, WCB, and smoking status were not significantly predictive of either DASH score or VAS. There was no difference in quality of life and function between arthroscopic and open tennis elbow release surgery at 12-months post-operative. Factors such as sex, age, and smoking status did not influence patient outcome, but there was some interaction between WCB and technique that was not well understood.