B D Owens1, K P Murphy, T R Kuklo. 1. Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, D.C. 20307, U.S.A.
Abstract
PURPOSE: This study was performed to review the results of our early experience with recalcitrant lateral epicondylitis treated arthroscopically. TYPE OF STUDY: This study is a case series consisting of consecutive patients with lateral epicondylitis treated arthroscopically by 1 surgeon. METHODS: Patients failing a minimum of 6 months of conservative treatment underwent arthroscopic release of the extensor carpi radialis brevis (ECRB) origin using the proximal medial and proximal lateral portals. Associated intra-articular pathology was noted and addressed. The ECRB lesions were classified according to their gross morphology and resected with a shaver. The lateral epicondyle was then decorticated with a burr. RESULTS: Sixteen patients with recalcitrant lateral epicondylitis were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 16 elbows undergoing surgery, 5 (31.3%) were noted to have a type I lesion, characterized as fraying of the undersurface of the ECRB. Five (31.3%) had a type II lesion noted by linear tears within the ECRB, and 6 (37.5%) had a type III lesion, consisting of a partial or complete avulsion of the ECRB origin. Concurrent intra-articular pathology (synovitis, osteophytes) was noted in 3 of 16 elbows (18.8%) and was addressed arthroscopically. All patients were followed-up for a minimum of 1 year; however, 4 patients were lost to follow-up for this retrospective review due to military reassignment. Follow-up was obtained on 12 of 16 (75%) of patients at an average length of 24.1 months (range, 15 to 33 months). All patients reported improvement with the procedure. The average return to unrestricted work was 6.0 days (range, 0 to 28 days). CONCLUSIONS: Arthroscopic release effectively treats lateral epicondylitis while also affording visualization of the joint space to address associated intra-articular pathology. Additionally, arthroscopic release is minimally invasive and allows early rehabilitation and return to normal activities.
PURPOSE: This study was performed to review the results of our early experience with recalcitrant lateral epicondylitis treated arthroscopically. TYPE OF STUDY: This study is a case series consisting of consecutive patients with lateral epicondylitis treated arthroscopically by 1 surgeon. METHODS:Patients failing a minimum of 6 months of conservative treatment underwent arthroscopic release of the extensor carpi radialis brevis (ECRB) origin using the proximal medial and proximal lateral portals. Associated intra-articular pathology was noted and addressed. The ECRB lesions were classified according to their gross morphology and resected with a shaver. The lateral epicondyle was then decorticated with a burr. RESULTS: Sixteen patients with recalcitrant lateral epicondylitis were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 16 elbows undergoing surgery, 5 (31.3%) were noted to have a type I lesion, characterized as fraying of the undersurface of the ECRB. Five (31.3%) had a type II lesion noted by linear tears within the ECRB, and 6 (37.5%) had a type III lesion, consisting of a partial or complete avulsion of the ECRB origin. Concurrent intra-articular pathology (synovitis, osteophytes) was noted in 3 of 16 elbows (18.8%) and was addressed arthroscopically. All patients were followed-up for a minimum of 1 year; however, 4 patients were lost to follow-up for this retrospective review due to military reassignment. Follow-up was obtained on 12 of 16 (75%) of patients at an average length of 24.1 months (range, 15 to 33 months). All patients reported improvement with the procedure. The average return to unrestricted work was 6.0 days (range, 0 to 28 days). CONCLUSIONS: Arthroscopic release effectively treats lateral epicondylitis while also affording visualization of the joint space to address associated intra-articular pathology. Additionally, arthroscopic release is minimally invasive and allows early rehabilitation and return to normal activities.