Arthroscopic Treatment Of Lateral Epicondylitis Research Articles

Modified arthroscopic tenotomy of the extensor carpi radialis brevis for refractory lateral epicondylitis: a cohort study

Different arthroscopic techniques exist for managing the exterior carpi radials brevis (ECRB) when treating refractory lateral epicondylitis. The purpose of this study is to compare the outcomes of a standard arthroscopic débridement with ECRB tendon release to an arthroscopic ECRB tenotomy distal to its insertion without débridement using a retrospective cohort study design. This study included patients underwent arthroscopic treatment of lateral epicondylitis during 2 different time periods: 2016 to 2019 (débridement) and 2019 to 2021 (modified tenotomy without débridement). Patients were assessed preoperatively and at the last follow-up with mayo elbow performance score (MEPS), disabilities of the arm, shoulder and hand (DASH) score, visual analog scale (VAS) of pain. A total of 69 patients completed the follow-up (38 in the débridement group and 31 in the tenotomy group). Patients in both groups showed significant improvements were found in MEPS, DASH, and VAS after surgery. Patients in the tenotomy group had higher MEPSs and reported less pain with a minimum 2 year follow-up after surgery. DASH scores between groups were similar at all time periods. Arthroscopic modified tenotomy of the ECRB without débridement improves function and pain significantly for patients with refractory lateral epicondylitis, which is not inferior to arthroscopic débridement technique.

METHODOLOGY IN ELBOW ARTHROSCOPY

At first arthroscopy was devised as a diagnostic tool, which then evolved in a therapeutically one with significant capabilities for the treatment of a wide specter of joint pathologies. The technique was first documented in 1912 when a Bruman (1932) explores the capabilities of arthroscope inserted into the elbow joint of human cadavers.
 In the last 30 years the indications for performing elbow arthroscopy show significant development worldwide. The purpose of the initially described elbow arthroscopies was as a diagnostic tool, removal of loose bodies in the joint, synovectomy and adhesiolysis. The arthroscopy’s capacity for elbow joint pathology treatment have grown greatly with the accumulation of anatomical knowledge and experience in arthroscopic surgery. In recent years, excellent results are being reported for the arthroscopic treatment of lateral epicondylitis, osteochondritis dissecans, osteoarthritis and contractures.
 Nonetheless, to perform an elbow arthroscopy requires high level of technical skillset. Accurate anatomical knowledge and sizeable arthroscopic experience is required. When taken into account the physiological peculiarity of the elbow region there is a risk of complications with relation to neuro-vascular injuries.
 Premise for achieving good to excellent results with minimal percentage of complications are selecting a suitable patient, preoperative preparation, practiced team and adequate equipment. This article’s purpose is to present contemporary methodology for the performance of arthroscopic surgery of the elbow joint.

Arthroscopic treatment of work-related lateral epicondylitis – prognostic factors

Lateral epicondylitis is a condition whose pathophysiology is poorly understood and whose optimal treatment divides physicians. Arthroscopy has proven its worth, with results similar to or better than open surgery. The purpose of this study was to look for prognostic factors for the outcomes of arthroscopic treatment of lateral epicondylitis. This was a retrospective, single-center study involving 39 cases (36 patients). Patients were split into two groups based on the Mayo Elbow Performance score (MEPS). A good result was defined as a score of 75 or better. The variables of interest were gender, age, body mass index, smoking habits, recognition as an occupational disease, duration of absence from work, cartilage involvement, presence of a capsular lesion and length of follow-up. The mean follow-up at review was 37.2 months (± 17.4). The average MEPS was 77.44 (± 15.51). Smoking was statistically related to a poor result (P = 0.0422) and a longer follow-up was statistically related to a good result (P = 0.0396). We identified two prognostic factors for lateral epicondylitis treated by arthroscopy. Smoking has a negative effect and ideally, patients should quit before surgical treatment. Time has a positive effect; thus patients should be informed that it will take several months or even years for their ailment to improve. Taking these factors into consideration will improve the functional outcomes of this surgery.

The Three-Portal Technique in Arthroscopic Lateral Epicondylitis Release.

Lateral epicondylitis, commonly referred to as tennis elbow, is a syndrome characterized by pain over the origin of the common extensor muscles of the fingers, hand and wrist at the lateral epicondyle. Reports of 70-90% response to conservative treatment at one year have been documented in the literature though refractory cases often require surgical management. Arthroscopic treatment of lateral epicondylitis allows for intra-articular visualization for concomitant pathology and localization of the Extensor Carpi Radialis Brevis tendon. Additionally, compared to the open technique, the arthroscopic technique has a lower morbidity and an earlier return to work and activity. Here we describe a three portal technique for improved visualization in arthroscopic lateral epicondylitis release.

Arthroscopic Treatment of Lateral Epicondylitis: Tenotomy Versus Debridement

To compare the outcome of 2 arthroscopic techniques for treating recalcitrant lateral epicondylitis. The study included patients undergoing arthroscopic treatment of lateral epicondylitis during 2 different time periods: April 2005 to October 2007 (tenotomy) and May 2009 to June 2010 (debridement). By using a patient-administered form, baseline information including QuickDASH (disabilities of the arm, shoulder and hand) score (primary outcome), visual analog scale (VAS) of pain, and VAS of function was recorded prospectively. To have the same follow-up period of minimum 4 years in the 2 groups, the follow-up was conducted at 2 different points of time. Of a total of 326 patients fulfilling the requirements for inclusion in the study, 283 patients (87%) were followed up (144 male and 139 female, median age 46 [21 to 65] years), 204 (87%) in the tenotomy group and 79 (88%) in the debridement group. In both groups, a significant improvement in the QuickDASH was found at the follow-up compared with baseline: from 60 to 12 in the debridement group (P < .001) and from 59 to 13 in the tenotomy group (P < .001). No statistically significant difference was found in baseline or follow-up QuickDASH, VAS of pain, VAS of function, or failure (reoperation) rate between the 2 groups. The mean length of sick leave was 2 weeks shorter in the debridement only group (P = .007). Both arthroscopic methods lead to a significant improvement of pain and function, and no statistically significant difference was found in any outcome parameters between the 2 techniques at this minimum 4-year evaluation. The results indicate that tenotomy of the extensor carpi radialis brevis may be an unnecessary step in the arthroscopic treatment of lateral epicondylitis Debridement only is a potentially less costly procedure, and the current finding of a mean 2 weeks shorter sick leave in the debridement only group proposes a substantial cost saving in a societal perspective. Level IV, therapeutic case series.

Arthroscopic Treatment of Lateral Epicondylitis

The primary cause of lateral epicondylitis of the elbow is chronic tendinopathy of the extensor carpi radialis brevis origin. Despite advances in the understanding of the pathoanatomy of lateral epicondylitis, a lack of consensus remains regarding the optimal surgical treatment when nonoperative treatment fails. Many different surgical procedures have been described in the literature, including several arthroscopic techniques. In this article, we describe our technique of arthroscopic evaluation, identification, and resection of symptomatic tendinosis tissue of the extensor origin. In our experience, arthroscopic management of patients with recalcitrant lateral epicondylitis can produce clinical improvement with successful long-term outcomes.

Nerve Injuries Resulting From Arthroscopic Treatment of Lateral Epicondylitis: Report of 2 Cases

Arthroscopic management of lateral epicondylitis is a commonly performed procedure that has a good track record of efficacy and safety based on the current literature. Here, we report 2 cases of nerve injuries resulting from this operation: 1 posterior interosseous nerve transection and 1 partial median nerve laceration.

Arthroscopic tennis elbow release

Lateral epicondylitis is one of the most common pain syndromes of the upper extremity.1 Approximately 90% of patients are successfully treated non-operatively but 10% may require surgical intervention due to residual symptoms impeding the patient's daily lifestyle activities.2 Different surgical procedures have been described but there is no consensus on the best surgical option.3 Many authors advocate the arthroscopic treatment of lateral epicondylitis.4–8 This article will explain and review the current literature regarding this procedure and the potential benefits of this technique.

Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication

The purpose of this study was to compare the early clinical results of arthroscopic extensor carpi radialis brevis (ECRB) release with and without bone decortication in the treatment of lateral epicondylitis. Thirty-eight patients who were surgically treated for lateral epicondylitis between 2004 and 2008 were included in this retrospective review. Among these 38 patients, 19 underwent arthroscopic ECRB release and 19 patients underwent both ECRB release with decortication of the lateral epicondyle. Outcome measures included pain assessment measured by visual analog scale (VAS) preoperatively, on postoperative day one, at two and 4 weeks postoperatively, and at the final follow-up visit. Functional evaluation was made with the Mayo Elbow Performance Index and grip strength measurement. Patients who underwent simple ECRB release had significantly less pain than patients who underwent ECRB release and decortication immediately postoperatively (p < 0.05). This group also showed a lower VAS score on exertion 2 weeks and 4 weeks after simple ECRB release (p < 0.05). The mean time taken to return to work was 24.2 ± 18.3 days in the group that underwent simple ECRB release and 39 ± 22.7 days in the group that underwent ECRB release with decortication (p < 0.05). Arthroscopic release of the ECRB is an effective method of treatment in patients with recalcitrant lateral epicondylitis. Decortication of the lateral epicondyle leads to increased pain postoperatively and did not improve clinical results.

Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow

Lateral epicondylitis is a common orthopedic problem. Rest, activity modification, and conservative therapies are generally efficacious in relieving symptoms in the majority of patients; however, a small percentage of people will experience refractory pain and require surgical intervention to alleviate their discomfort. Surgical release of the common extensor origin can be done through an open, percutaneous, or arthroscopic approach. This prospective study includes 33 patients with chronic resistant lateral epicondylitis who had received conservative treatment including modification of activity and 2 injections of 80mg of hydrocortisone, for more than 6months, aiming to compare two different techniques of treatment. The first group included 14 patients with a mean age of 42years treated by arthroscopic release of common extensor origin. The second group included 19 patients with a mean age of 48years treated by percutaneous tenotomy. The mean follow up was 12months for the arthroscopic group and 10months for the percutaneous tenotomy group. The results were evaluated according to the Disabilities of the Arm, Shoulder and Hand (DASH) score and the visual analogue scale (VAS). In the first group (treated by arthroscopy), the average DASH score improved from 72 to 48 and the average VAS improved from 9.1 to 2. In the second group (treated by percutaneous tenotomy), the average DASH score improved from 70 to 50 and the average VAS improved from 9 to 2.1. Concerning patient satisfaction after surgery, in the first group 7 patients (50%) were pleased, 6 (42.85%) were satisfied and 1 case (7.14%) was not satisfied. In the second group, 7 patients (36.84%) were pleased, 10(52.63%) were satisfied and 2 cases (10.52%) were not satisfied. Both arthroscopic and percutaneous release of the common extensor origin can be effective in treatment of lateral epicondylitis. Arthroscopic treatment of lateral epicondylitis gives more favorable results than percutaneous tenotomy. Although technically more difficult than percutaneous tenotomy, arthroscopy has the advantage of visualization of the pathology and much better improvement of elbow functions.

Arthroscopic Treatment of Lateral Epicondylitis

Arthroscopic Treatment of Lateral Epicondylitis

Arthroscopic Treatment of Lateral Epicondylitis

Arthroscopic Treatment of Lateral Epicondylitis

Arthroscopic Treatment of Lateral Epicondylitis

Lateral epicondylitis refractory to conservative care can be effectively treated by arthroscopic release of the extensor carpi radialis brevis origin. Advantages to the technique include the ability to address other intra-articular sources of pain (capsular tears, radiocapitellar plica, etc.), a potentially faster return to work and sports, and a smaller incision. This article provides step-by-step descriptions and illustrations of the surgical technique.

Functional outcomes after arthroscopic treatment of lateral epicondylitis

Background.The purpose of this study was to evaluate surgical outcomes of arthroscopic débridement for lateral epicondylitis using a validated, patient-assessed scoring system as well as conventional outcome measures. We also wanted to identify potential predictive factors that may be associated with the outcomes. Methods.A total of 20 elbows in 18 patients with chronic lateral epicondylitis who underwent arthroscopic surgery were included. There were nine men and nine women with a mean age of 54 years (range 42-71 years). Operative treatment consisted of débridement of the extensor carpi radialis brevis (ECRB) origin and resection of the radiocapitellar synovial plica interposed in the joint. Outcomes were assessed using a patient rating, visual analogue scale (VAS) pain score, the Japanese Orthopaedic Association (JOA) elbow score, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. The average length of follow-up was 28 months (range 24-40 months). Results.After surgery, according to the patients’ reports, 14 of 20 elbows were much better, and 6 elbows were better. A mean preoperative VAS pain score at rest of 3.9 points improved to 0.3 points (P <0.0001), and that during activity improved from 7.8 points to 0.9 points (P < 0.0001). The mean preoperative JOA elbow score of 29 points was improved to 90 points (P < 0.0001). The mean postoperative DASH score was 10.6 (range 0-50). Absent of T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) (P = 0.02) and receiving public assistance (P = 0.01) were significantly associated with worse DASH scores. Conclusions.Arthroscopic release was a satisfactory procedure for chronic lateral epicondylitis. Preoperative MRI of the ECRB origin and socioeconomic factors were significantly associated with postoperative residual symptoms evaluated with the DASH score.

Elbow arthroscopy: what can we do?

Purpose of review Elbow arthroscopy is an effective and safe method in the management of a variety of elbow disorders. The purpose of this review is to briefly discuss the basics of elbow arthroscopy and to highlight recent literature and techniques that demonstrate the expanding utility of arthroscopy in treating elbow disorders. Recent findings Advances in arthroscopic surgery and equipment over the last several years have made elbow arthroscopy an effective and safe alternative for the management of a variety of elbow disorders. Common themes include treatment of benign bone lesions, fractures, degenerative arthritis and posterior lateral impingement. Also, long-term follow-up for arthroscopic treatment of lateral epicondylitis has shown its durability and effectiveness. Summary These techniques and studies emphasize the increasing preference for elbow arthroscopy made by surgeons to treat patients with a variety of elbow disorders.

Long-term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

Background: The most commonly accepted theory pertaining to the pathogenesis of the lateral epicondylitis points to a degenerative, non-inflammatory lesion in the origin of the extensor carpi radialis brevis (ECRB). The lesion, caused by overuse, is characterized by microscopic tears of the ECRB origin that eventually are replaced by non-reparative tissue consisting of disorganized collagen, immature fibroblasts, and vascular elements. Currently, there is a lack of consensus on which management is best suited for patients with lateral epicondylitis – operative or non-operative. While most patients respond to non-operative management, up to 25% of patients has been identified in the literature as requiring operative management. Several operative techniques with documented short-term success have been described in the literature. This study evaluates the long-term outcome of an arthroscopic treatment of lateral epicondylitis performed by the first author.

Long-Term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

Background In a previously published report of the authors’ arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients. Hypothesis Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes. Study Design Case series; Level of evidence, 4. Methods Forty patients (42 elbows) with lateral epicondylitis who had not responded to nonoperative management were treated with arthroscopic resection of pathologic tissue. Thirty of these patients (30 elbows) were located for extended follow-up. At a mean follow-up of 130 months (range, 106–173 months), patients were asked to use a numeric scale to rate their elbow pain from 0 (no pain) to 10 (severe pain). Patients were also asked to rate their elbows according to the functional portion of the Mayo Clinic Elbow Performance Index. Results The mean pain score at rest was 0; with activities of daily living, 1.0; and with work or sports, 1.9. The mean functional score was 11.7 out of a possible 12 points. No patient required further surgery or repeat injections after surgery. One patient continued to wear a counterforce brace with heavy activities. Twenty-three patients (77%) stated they were “much better,” 6 patients (20%) stated they were “better,” and 1 patient (3%) stated he was the same. Twenty-six patients (87%) were satisfied, and 28 patients (93%) stated they would have the surgery again if needed. Conclusion Arthroscopic removal of pathologic tendinosis tissue is a reliable treatment for recalcitrant lateral epicondylitis. The early high rate of success in patients was maintained at long-term follow-up.

Arthroscopic Treatment of Lateral Epicondylitis

Clinical and cadaveric studies were done to investigate the role of a degenerative fringe of the radiocapitellar complex subluxating in the radiocapitellar joint in patients with lateral epicondylitis. In the clinical study, arthroscopic resection of this capsular complex was done. Thirty patients with recalcitrant symptoms of lateral epicondylitis for a minimum of 9 months had surgery. In all patients at arthroscopy, a collar-like band of radiocapitellar capsular complex was found to impinge on the radial head and subluxate into the radiocapitellar joint with manipulation under direct vision. Histologic analyses of the resected tissue showed hyaline degeneration and fibrosis. There were no complications in this series. Twenty-eight patients had complete relief of symptoms by this procedure within 2 weeks of surgery. The average time until return to work was 7 days. Elbow arthroscopy was done in 34 cadaveric elbows to examine the relationship of the annular ligament, the lateral joint capsule, and the radial head. A degenerative capsular fold impinging on the radial head was seen in 15 elbows. A classification system, based on the relationship of the capsular fold to the radial head is described. In Type 1 (19 elbows), the radial head is completely exposed. In Type 2 (six elbows), there is partial coverage of the radial head by the capsuloligamentous complex without interposition into the joint in any position. In Type 3 elbows (six elbows), there is subluxation of the capsular edge into the joint, whereas in Type 4 elbows (three elbows), the radial head is completely obscured throughout the range of motion. The lesion was equally prevalent in men and women. The arthroscopic findings at the time of surgery in the clinical group were the same as the Grade 2 and Grade 3 changes that were seen in cadaveric specimens.

Arthroscopic treatment of lateral epicondylitis: Indication, technique and early results

The purpose of this study is to present the results of the arthroscopic treatment of lateral epicondylitis. Twenty patients with lateral epicondylitis (mean age 42 years) were treated arthroscopically. The average duration of symptoms prior to surgery was 14 months. The arthroscopic joint inspection showed an intact capsule in seven patients (type-I lesion), in eight patients a linear capsule tear (type-II lesion) and in six patients a complete rupture of the capsule (type-III lesion). An associated intraarticular pathology was documented in eight patients. Within an average follow-up period of 1.8 years, local pain and function were documented and analyzed. Subjective pain at rest was reduced from 5.0 to 0.5 points, pain at daily living activities from 6.0 to 1.0 points and pain at athletic activities from 7.3 to 1.2 points in the VAS score. Function increased from 5.2 to an average value of 10.9 (max. 12 points). Patients returned back to work after 3.2 weeks. In conclusion, the arthroscopic release in patients with radial epicondylitis is a reproducible method with a marked postoperative increase in function within a short rehabilitation period.