Original Article| Volume 34, ISSUE 12, P3177-3184, December 2018

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Arthroscopic Versus Open Lateral Release for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Trial


      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.


      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.


      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).


      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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        • Allander E.
        Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes.
        Scand J Rheumatol. 1974; 3: 145-153
        • Shiri R.
        • Viikari-Juntura E.
        Lateral and medial epicondylitis: Role of occupational factors.
        Best Pract Res Clin Rheumatol. 2011; 25: 43-57
        • Sanders T.L.
        • Maradit Kremers H.
        • Bryan A.J.
        • Ransom J.E.
        • Smith J.
        • Morrey B.F.
        The epidemiology and health care burden of tennis elbow: A population-based study.
        Am J Sports Med. 2015; 43: 1066-1071
        • Hamilton P.G.
        The prevalence of humeral epicondylitis: A survey in general practice.
        J R Coll Gen Pract. 1986; 36: 464-465
        • Hume P.A.
        • Reid D.
        • Edwards T.
        Epicondylar injury in sport: Epidemiology, type, mechanisms, assessment, management and prevention.
        Sports Med. 2006; 36: 151-170
        • De Smedt T.
        • de Jong A.
        • Van Leemput W.
        • Lieven D.
        • Van Glabbeek F.
        Lateral epicondylitis in tennis: Update on aetiology, biomechanics and treatment.
        Br J Sports Med. 2007; 41: 816-819
        • Calfee R.P.
        • Patel A.
        • DaSilva M.F.
        • Akelman E.
        Management of lateral epicondylitis: Current concepts.
        J Am Acad Orthop Surg. 2008; 16: 19-29
        • Tosti R.
        • Jennings J.
        • Sewards J.M.
        Lateral epicondylitis of the elbow.
        Am J Med. 2013; 126: 357.e1-357.e6
        • Boyer M.I.
        • Hastings H.
        Lateral tennis elbow: “Is there any science out there?.
        J Shoulder Elbow Surg. 1999; 8: 481-491
        • Smidt N.
        • Assendelft W.J.J.
        • van der Windt D.A.W.M.
        • Hay E.M.
        • Buchbinder R.
        • Bouter L.M.
        Corticosteroid injections for lateral epicondylitis: A systematic review.
        Pain. 2002; 96: 23-40
        • Struijs P.A.
        • Kerkhoffs G.M.M.J.
        • Assendelft W.J.J.
        • Van Dijk C.N.
        Conservative treatment of lateral epicondylitis: Brace versus physical therapy or a combination of both—A randomized clinical trial.
        Am J Sports Med. 2004; 32: 462-469
        • Nirschl R.P.
        • Pettrone F.A.
        Tennis elbow. The surgical treatment of lateral epicondylitis.
        J Bone Joint Surg Am. 1979; 61: 832-839
        • Stapleton T.
        • Baker Jr., C.
        Arthroscopic treatment of lateral epicondylitis: A clinical study.
        Arthroscopy. 1996; 12 (abstr): 365-366
        • Hudak P.L.
        • Amadio P.C.
        • Bombardier C.
        Development of an upper extremity outcome measure: The DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG).
        Am J Ind Med. 1996; 29: 602-608
        • Beaton D.E.
        • Katz J.N.
        • Fossel A.H.
        • Wright J.G.
        • Tarasuk V.
        • Bombardier C.
        Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity.
        J Hand Ther. 2001; 14: 128-146
        • Rompe J.D.
        • Overend T.J.
        • MacDermid J.C.
        Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire.
        J Hand Ther. 2007; 20 (quiz 11): 3-10
        • Baker C.L.
        • Murphy K.P.
        • Gottlob C.A.
        • Curd D.T.
        Arthroscopic classification and treatment of lateral epicondylitis: Two-year clinical results.
        J Shoulder Elbow Surg. 2000; 9: 475-482
        • Gummesson C.
        • Atroshi I.
        • Ekdahl C.
        The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery.
        BMC Musculoskelet Disord. 2003; 4: 11
        • Owens B.D.
        • Murphy K.P.
        • Kuklo T.R.
        Arthroscopic release for lateral epicondylitis.
        Arthroscopy. 2001; 17: 582-587
        • Peart R.E.
        • Strickler S.S.
        • Schweitzer K.M.
        Lateral epicondylitis: A comparative study of open and arthroscopic lateral release.
        Am J Orthop. 2004; 33: 565-567
        • Solheim E.
        • Hegna J.
        • Øyen J.
        Arthroscopic versus open tennis elbow release: 3- to 6-year results of a case-control series of 305 elbows.
        Arthroscopy. 2013; 29: 854-859
        • Burn M.B.
        • Mitchell R.J.
        • Liberman S.R.
        • Lintner D.M.
        • Harris J.D.
        • McCulloch P.C.
        Open, arthroscopic, and percutaneous surgical treatment of lateral epicondylitis: A systematic review.
        Hand (N Y). 2017; (155894471770124)

      Linked Article

      • Editorial Commentary: Dealer's Choice for Arthroscopic Versus Open Lateral Epicondylitis Release? It's Not That Simple
        ArthroscopyVol. 34Issue 12
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          The 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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