PROSPECTIVE STUDY OF ARTHROSCOPIC TENNIS ELBOW RELEASE

Abstract

Many procedures have been described for the operative treatment of tennis elbow (lateral epicondylitis). Arthroscopic tennis elbow release is a relatively recent development. The aim of this study was to review our early results of arthroscopic tennis elbow release.

This was a prospective study of 29 consecutive patients (30 elbows) with tennis elbow refractory to conservative management, who underwent arthroscopic tennis elbow release performed by one surgeon. At surgery, arthroscopic assessment of the elbow joint was performed followed by capsulectomy and debridement of the Extensor Carpi Radialis Brevis (ECRB) tendon origin using the proximal lateral, anteromedial and anterolateral portals. Associated intra-articular pathology was noted. The ECRB lesions were classified according to their gross morphology and resected with a shaver but the insertion site was not decorticated. Patients were assessed preoperatively, at 2 weeks and at 3 months using the DASH score.

29 patients with tennis elbow were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 30 elbows undergoing surgery, 22 were noted to have a Nirschl type I lesion (intact capsule), 7 had a type II lesion (linear capsular tear) and 1 had a type 3 lesion (capsular rent). Degenerative articular changes were noted in 18 elbows. Arthroscopic debridement was undertaken if appropriate. Three elbows had eccentric radial heads. Radial plicae which were impinging on the radial head were present in three patients.

Mean follow up is 9 months (1–23). 1 patient was lost to follow up.

There was a significant improvement in DASH scores (p< 0.05) at 2 weeks post operatively. This improvement became more significant at 3 months post operatively. This is a worst case scenario analysis using a paired t test. 6 patients failed to improve, 1 partially improved and 1 was revised and improved.

There were no surgical complications; however, one patient has post operative stiffness which required an arthroscopic release.

The early results of this study would suggest arthroscopic tennis elbow release is an effective treatment for tennis elbow, which in addition also allows assessment of the elbow joint and the potential to address associated intra-articular pathology if required. This minimally invasive technique has been demonstrated to be safe and affords early post operative rehabilitation and return to normal activities.