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Arthroscopic Treatment of Lateral Elbow Pain Mimicking Lateral Epicondylitis

Long-term Follow-up of a Unique Surgical Protocol

Sochol, Kristen M., MD, MS; London, Daniel A., MD, MS; Rothenberg, Edward S., MD; Hausman, Michael R., MD

Techniques in Hand & Upper Extremity Surgery: March 2019 - Volume 23 - Issue 1 - p 27–30
doi: 10.1097/BTH.0000000000000217
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Hypothesis and/or Background: The failure rate of extensor carpi radialis brevis debridement for refractory lateral epicondylitis is reported around 15%. Our novel arthroscopic treatment is predicated on the hypothesis that lateral epicondylitis is an intra-articular problem related to a variation of the capsule-meniscal anatomy that impinges on the radiocapitellar joint. We report long-term outcomes of 35 patients treated with a novel arthroscopic resection of their capsulosynovial fringe.

Methods: All patients failed nonoperative treatment but had temporary improvement with an intra-articular injection. Arthroscopic treatment involved resecting the meniscus and the proximal edge of the orbicular ligament, followed by a tendon-sparing anterolateral capsulectomy. 35 patients underwent evaluation on average 9.2 years after surgery. Outcome measures included VAS, DASH, and questions on return to sports, satisfaction, and perceived benefit of surgery.

Results: Median pain scores improved from 8 of 10 preoperatively to 0 of 10 postoperatively. This change was clinically and statistically significant, with 1 patient still requiring pain medication. Median DASH score at final follow-up was 1. Overall, 30 patients rated their postoperative outcome as much better, 5 rated it as better, and 0 reported their symptoms to be unchanged or worsened. All 35 patients stated they were happy they underwent the procedure and perceived a benefit. Totally, 4 of 35 patients had postoperative complications (2 with ulnar nerve symptoms, 2 with persistent pain), with one requiring revision surgery for persistent pain.

Discussion and/or Conclusions: We report promising long-term clinical and functional results of a novel arthroscopic resection of the capsulosynovial complex in lateral epicondylitis.

Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

This study (Study number: 14-00281) was approved by the Institution Review Board of Mount Sinai School of Medicine.

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Kristen M. Sochol, MD, MS, 5 E. 98th St., Box 1198, New York, NY 10029. E-mail: kristen.meier@mountsinai.org.

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