Open release versus radiofrequency microtenotomy in the treatment of lateral epicondylitis: a prospective randomized controlled trial

Long-Term Functional Outcomes Following Radiofrequency Microtenotomy for Lateral Epicondylitis of Elbow

Background Lateral epicondylitis or 'Tennis elbow' is a common cause of elbow pain in the middle-aged group caused by tendinosis of the common extensor origin of the forearm muscles. Though no obvious aetiology is identified in most cases, it could be attributed to repetitive overuse of wrist extensors or supinator muscles. This condition is generally self-limiting but may become persistent in a few cases. Radiofrequency microtenotomy (RFM) is a minimally invasive surgical procedure for recalcitrant lateral epicondylitis of the elbow. This involves targeted coblation of pathological tissue at significantly lower temperatures. Objectives The aim of this study was to evaluate the therapeutic efficacy and report long-term results and recurrences in patients treated with RFM. Methods We present long-term results with a mean eight-year follow-up in a case series of 19 patients. All patients had a minimum of six months (mean 23.25 months and range: 6-36 months) of conservative management which included steroid injections prior to being offered RFM. This was a retrospective case series of 20 elbows (in 19 patients) who underwent RFM. The majority of patients (65%) were females. The operation was carried out in the dominant arm in 55% of patients. Results Results were analysed by comparing pre-operative and post-operative QuickDASH scores (Disabilities of the Arm, Shoulder and Hand Score) obtained at one year and eight years post-operatively. We found an improvement in QuickDASH scores from a mean of 61.7 pre-operatively to 18.9 (p-value < 0.0001) and 8.5 (p-value < 0.0001) at one year and eight years, respectively. The mean pain component of the QuickDASH scores decreased from 4.8 to 2.0 and 1.5, respectively, at one year and eight years (p-value < 0.0001). More than 83% of the patients had excellent to good functional improvement. Conclusion RFM is a reliable modality for treating recalcitrant lateral epicondylitis of the elbow with excellent long-term results.

Percutaneous microtenotomy using a microdebrider coblation wand for the treatment of lateral epicondylitis: A systematic review

BACKGROUND

Lateral epicondylitis is one of the most common causes of elbow pain. Most patients recover with conservative treatments; however, some patients require surgical intervention. There are 3 common procedures offered: open tenotomy, arthroscopic tenotomy, and percutaneous microtenotomy. In comparison, percutaneous microtenotomy has been proven as a less invasive procedure to treat lateral epicondylitis. We reviewed the literature on the safety and efficacy of using a microdebrider coblation wand to treat lateral epicondylitis, and we compared its outcomes to open and arthroscopic tenotomy.

METHODS

A search was completed through PubMed Central, Google Scholar, EBSCO host, and Embase for studies that performed percutaneous microtenotomy with a microdebrider coblation wand to treat lateral epicondylitis. Studies were then screened to determine if they met inclusion and exclusion criteria and were reviewed for data analysis and potential risks of bias.

RESULTS

A total of 27 articles were identified and 9 articles (eight studies) met the inclusion criteria. Small sample sizes in the studies and heterogeneity of the methodology limited the capacity to carry out a meta-analysis. Percutaneous microtenotomy outcomes seem to be favorable for reduced pain, increased grip strength, and improved functional outcomes, which were similar to outcomes reported with the other surgical techniques. There were no major adverse events reported in the studies secondary to the use of the microdebrider coblation wand. Procedure time and return to daily activities were shorter for the microtenotomy group.

CONCLUSION

Percutaneous microtenotomy performed with a microdebrider coblation seems to be an effective treatment for lateral epicondylitis that provides similar outcomes to the surgical techniques with a lower rate of complications.

Management of lateral epicondylitis

Lateral epicondylitis is the most common cause of lateral elbow pain. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore constitutes a major public health issue. This article reviews the pathophysiological factors involved in lateral epicondylitis, as well as the tools available for establishing the diagnosis and ruling out other causes of lateral elbow pain. Finally, the non-operative and surgical treatment options are discussed in detail.

Comparison of arthroscopic debridement and open debridement in the management of lateral epicondylitis: A systematic review and meta-analysis

BACKGROUND

Previous studies have reported that both arthroscopic debridement (AD) and open debridement (OD) of extensor carpi radialis brevis are effective in the treatment of lateral epicondylitis. Despite this, few studies have focused on the comparative outcomes of these 2 procedures. The aim of this study was to assess whether AD is superior to OD in managing lateral epicondylitis.

METHODS

A systematic search of the literature was conducted to identify relevant articles that were published in MEDLINE, Embase, and Cochrane Library databases during January 2019. All studies comparing the efficacy of AD and OD in terms of failure rate, complication rate, and clinical outcome measures were included. Statistical analysis was performed using Review Manager.

RESULTS

Six clinical trials were included in the current meta-analysis. There was no significant difference with regard to disabilities of the arm, shoulder, and hand scores, visual analog scale, and failure rate. There was a statistically significant difference in surgical time in favor of the OD (mean difference [MD], -11.45, 95% confidence interval [CI], -12.45 to -10.44, I = 0%, P < .001). There was no significant difference of complication rate between the OD group (0.6%) and the AD group (1.0%) (MD, 0.62; 95% CI, 0.12-3.06; P = .55) CONCLUSION:: There was no significant difference between arthroscopic and open surgery with regards to failure rate, functional outcome score, and complication rate. The current meta-analysis found that arthroscopic surgery had a longer surgical time than open surgery for lateral epicondylitis.