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Tennis Elbow Repair With or Without Suture Anchors: A Randomized Clinical Trial

Monto, Raymond Rocco MD

Techniques in Shoulder & Elbow Surgery: September 2014 - Volume 15 - Issue 3 - p 92–97
doi: 10.1097/BTE.0000000000000027

The surgical treatment of chronic severe tennis elbow refractory to extensive traditional nonoperative management remains controversial. This prospective, double-blinded, longitudinal study is the first to compare the clinical results of traditional elbow arthroscopy and extensor carpi radialis brevis tendon (ECRB) debridement and decortication (Nirschl procedure) with combined elbow arthroscopy, ECRB debridement, decortication, and suture anchor repair. Sixty patients with chronic tennis elbow failing a minimum of 6 months of nonoperative treatment (NSAIDS, oral steroids, standardized physical therapy, bracing, and cortisone injections) were randomized into 2 groups for surgical management. All patients had preoperative MRI examinations and underwent blinded clinical scoring using Mayo elbow and DASH scoring over a 12-month postoperative period. The Mayo and DASH functional scores were superior in the suture anchor group at every scoring interval (P=0.001, 95% confidence interval). Three clinical failures were reported in the unanchored group and none in the anchored group. Although both techniques proved useful in the treatment of refractory cases of severe tennis elbow, the use of suture anchors to reattach the ECRB tendon after debridement and decortication provided significantly better short-term and long-term clinical results with limited additional burden of surgical risk, operative time, or expense.

Nantucket Cottage Hospital, Nantucket, MA

The author declares no conflict of interest.

Reprints: Raymond Rocco Monto, MD, Nantucket Cottage Hospital, Nantucket, MA 02554 (e-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.