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Arthroscopic Treatment of Lateral Epicondylitis: Long term Follow-up of a Unique Surgical Protocol
Kristen M. Meier, MD,MS; Daniel London, MD, MS; Edward Rothenberg, BA; Eliana Saltzman, BA; Michael R. Hausman, MD
Mount Sinai School of Medicine, New York, NY
Introduction: The failure rate of ECRB debridement for refractory lateral epicondylitis (LE) is variably reported at about 15%. Our novel, arthroscopic treatment is predicated on the hypothesis that LE is an intraarticular problem related to a variation of the capsule-meniscal anatomy that impinges on the radiocapitellar joint. We report long-term outcomes of 35 patients treated with a novel arthroscopic resection of their capsulosynovial fringe.
Materials and Methods: All patients failed non-operative treatment, but had temporary (>6 week) improvement with an intraarticular triamcinolone injection at the radiocapitellar joint. Arthroscopic treatment begins in the posterior radiocapitellar joint by resecting the meniscus and the proximal edge of the orbicular ligament at its insertion onto the coronoid insertion base. A tendon-sparing anterolateral capsulectomy is then performed, sparing the LUCL. 35/78 patients who underwent this procedure from 2000-2013 could be recalled for evaluation on average 9.2 years (SD: 2.66) after surgery. Table lists descriptive data. Outcomes included VAS, DASH, and questions on return to sports, satisfaction, and perceived benefit of surgery. Non-parametric descriptive statistics were performed to assess final DASH scores and questionnaire data. The Wilcoxon Sign-Rank test was performed to assess the change in pain scores.
Results: Median pain scores improved from 8/10 (IQR: 1) preoperatively to 0/10 (IQR: 1) postoperatively. The median change of -7 points was clinically and statistically significant (p<0.0001), with 1 patient still requiring pain medication. Median DASH score at final follow-up was 1 (IQR: 6). 25/35 patients reported participation in sports prior to injury, with 22/25 affected by elbow symptoms. After surgery, 22/25 reported returning to pre-symptom participation levels, while 1 patient reported a decreased level. Overall, 30 patients rated their post-operative outcome as much better, 5 rated it as better, and 0 reported their symptoms to be unchanged or worsened. All 35 patients stated they were happy they underwent the procedure and perceived a benefit. 4/35 patients had post-operative complications (2 with ulnar nerve symptoms, 2 with persistent pain), with one requiring revision surgery for persistent pain.
Conclusion: We report promising long-term clinical and functional results of a novel arthroscopic resection of the capsulomeniscal complex in LE.
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