Ultrasound guided percutaneous tenotomy for lateral epicondylosis

Abstract

Lateral elbow tendinopathy is a common condition affecting two to three percent of the population. While non-operative management is the mainstay of treatment, 10-15% remain refractory. Ultrasonic percutaneous tenotomy is a recent therapeutic option for clinicians to treat lateral elbow tendinopathy. The goal of this study was to evaluate the survival rate of ultrasonic percutaneous tenotomy in the treatment of lateral elbow tendinopathy. 83 patients underwent ultrasonic percutaneous tenotomy from September 2015 to August 2018 and met full inclusion criteria to participate. 63 patients consented to enroll in the study, with 50 (79.4%) completing the postoperative questionnaire. Data obtained included range of motion, patients’ report of improvement, Quick Dash Score (Q-Dash), Visual Analogue Scale (VAS) pain, VR 12, Mayo Elbow Performance, patient satisfaction, further post-operative adjunct procedures which included additional steroid injections, platelet-rich plasma (PRP) injections or need for reoperation at a minimum of 12 months post procedure. Overall survival rate for ultrasonic percutaneous tendinopathy was 94% (47/50). Three patients required post-operative adjunct procedures, two received steroid injections and one required PRP injection. Mean VAS score improved from 8.1 to 2.8 in the no failure group vs 7.9 to 2.7 in the failure group. Mean postoperative Mayo Elbow score and Q-DASH score was 89 (range 60 to 100) and 12.7 (range 2.3 to 61.4), respectively. 84 percent of patients were either very satisfied (N=31) or satisfied (N=11) with their procedure. This three year study demonstrates that ultrasonic percutaneous tenotomy appears to be a safe and efficacious therapeutic option with a high survival rate for patients with recalcitrant lateral elbow tendinopathy.