Purpose
The purpose of this randomized clinical trial was to determine whether quality of
life and function, as measured using subjective questionnaires and clinical assessment,
are different after open versus arthroscopic debridement of the pathologic extensor
carpi radialis brevis origin in the treatment of lateral epicondylitis at 1 year postoperatively.
Methods
Patients older than 16 years with a minimum of 6 months of nonoperative management
for lateral epicondylitis were recruited into this prospective, single-blinded randomized
clinical trial. Patients were randomized intraoperatively to undergo open or arthroscopic
release. Scores on the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure;
visual analog scale (VAS); and Patient-Rated Tennis Elbow Evaluation (PRTEE) were
recorded preoperatively and 3, 6, and 12 months postoperatively. Grip strength was
assessed by an independent assessor. All patients followed the same physiotherapy
regimen.
Results
Between 2002 and 2014, we randomized 37 patients to the open technique and 38 to the
arthroscopic technique. Both groups improved significantly from preoperatively to
12 months postoperatively (P < .001). There were no significant differences between the 2 groups when comparing
the DASH score, VAS score, PRTEE score, or grip strength at any time point. The only
significant difference between study groups was that the arthroscopic technique resulted
in a longer surgery time: 34.0 minutes (standard error of the mean, 2.9 minutes) versus
22.5 minutes (standard error of the mean, 1.3 minutes) (P = .005).
Conclusions
Comparing the open versus arthroscopic technique in the surgical management of lateral
epicondylitis through a randomized clinical trial, we determined that there was no
difference between the 2 operative modalities when examining the DASH score, VAS score,
PRTEE score, grip strength, or complication rate at 12 months postoperatively. A shorter
operative time coupled with potentially less setup time may favor open release.
Level of Evidence
Level II, lower-quality randomized trial.
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Article info
Publication history
Accepted:
July 5,
2018
Received:
November 7,
2017
Footnotes
See commentary on page 3185
The authors report the following potential conflict of interest or source of funding: The Alexander Gibson Chair Fund and the Pan Am Clinic Foundation provided funding for this study. T.C. receives support from University of Manitoba Alexander Gibson Fund. S.M. receives support from University of Manitoba Alexander Gibson Fund. J.L. receives support from University of Manitoba Alexander Gibson Fund. Y.Z. receives support from University of Manitoba Alexander Gibson Fund. J.D. receives support from University of Manitoba Alexander Gibson Fund. P.M. receives support from University of Manitoba Alexander Gibson Fund. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 Published by Elsevier on behalf of the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Dealer's Choice for Arthroscopic Versus Open Lateral Epicondylitis Release? It's Not That SimpleArthroscopyVol. 34Issue 12
- PreviewThe most efficacious treatment for patients with persistent lateral epicondylitis who have not adequately improved despite undergoing extended nonoperative measures may be arthroscopic. One advantage is the capability of the surgeon to fully assess the elbow intra-articularly. Second, the incision is often considered less appealing to both patients and surgeons than portal-site incisions. A final potential benefit is the opportunity for the occasional elbow arthroscopist to take advantage of a “best-case” clinical setting to perform a thorough arthroscopic diagnostic evaluation of both the anterior and posterior elbow compartments and improve his or her elbow arthroscopic skills, because patients with lateral epicondylitis rarely have advanced arthritis or capsular contractures and have infrequently undergone prior elbow surgery.
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