Marcus Bateman1, Chris Littlewood2, Beth Rawson3, Amol A Tambe1. 1. Orthopaedic Department, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK. 2. Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK. 3. Library Services, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
Abstract
BACKGROUND: There is no consensus on the most suitable treatment for tennis elbow but, in the USA, surgical intervention is increasing despite a lack of supportive research evidence. The aim of this systematic review was to provide a balanced update based on all relevant published randomized controlled trials conducted to date. METHODS: An electronic search of MEDLINE, EMBASE, CINAHL, BNI, AMED, PsycINFO, HBE, HMIC, PubMed, TRIP, Dynamed Plus and The Cochrane Library was complemented by hand searching. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data were synthesized narratively, based on levels of evidence, as a result of heterogeneity. RESULTS: Twelve studies of poor methodological quality were included. The available data suggest that surgical interventions for tennis elbow are no more effective than nonsurgical and sham interventions. Surgical technique modifications may enhance effectiveness compared to traditional methods but have not been tested against a placebo. CONCLUSIONS: Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. Given the recalcitrant nature of tennis elbow for some patients, further research in the form of a high-quality placebo-controlled surgical trial with an additional conservative arm is required to usefully inform clinical practice.
BACKGROUND: There is no consensus on the most suitable treatment for tennis elbow but, in the USA, surgical intervention is increasing despite a lack of supportive research evidence. The aim of this systematic review was to provide a balanced update based on all relevant published randomized controlled trials conducted to date. METHODS: An electronic search of MEDLINE, EMBASE, CINAHL, BNI, AMED, PsycINFO, HBE, HMIC, PubMed, TRIP, Dynamed Plus and The Cochrane Library was complemented by hand searching. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data were synthesized narratively, based on levels of evidence, as a result of heterogeneity. RESULTS: Twelve studies of poor methodological quality were included. The available data suggest that surgical interventions for tennis elbow are no more effective than nonsurgical and sham interventions. Surgical technique modifications may enhance effectiveness compared to traditional methods but have not been tested against a placebo. CONCLUSIONS: Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. Given the recalcitrant nature of tennis elbow for some patients, further research in the form of a high-quality placebo-controlled surgical trial with an additional conservative arm is required to usefully inform clinical practice.
Authors: Marcus Bateman; Jonathan P Evans; Viana Vuvan; Val Jones; Adam C Watts; Joideep Phadnis; Leanne Bisset; Bill Vicenzino Journal: Trials Date: 2021-05-10 Impact factor: 2.279
Authors: M Bateman; B Saunders; C Littlewood; D Davis; J Beckhelling; K Cooper; A Skeggs; N E Foster; B Vicenzino; J C Hill Journal: Pilot Feasibility Stud Date: 2022-08-11