Three Surgical Methods Found Equally Good for Lateral Epicondylitis
References: AOSSM at the AAOS 72nd Annual Meeting. Presented Feb. 26, 2005
Whether a surgeon operates for lateral epicondylitis (Tennis Elbow) using an open, arthroscopic, or percutaneous method appears to have no significant effect on patient outcomes, according to a retrospective review of 102 patients treated by one surgeon over seven years.
The findings were described in a presentation here before the American Orthopaedic Society for Sports Medicine, in affiliation with the 72nd annual meeting of the American Academy of Orthopaedic Surgeons.
Joshua Szabo, MD, fellow at the Mississippi Sports Medicine and Orthopaedic Center in Jackson, showed videos to illustrate the procedures as performed by one surgeon. "We do the same things arthroscopically as we do open," he pointed out. S. Felix H. Savoie III, MD, senior surgeon at the same institution, performed all the procedures reviewed, and he answered questions about the paper.
In this review, 23 patients received percutaneous procedures, 38 had arthroscopic procedures, and 41 had open surgeries. All patients had a minimum of three months of conservative care without success, with the average duration of conservative care (including cortisone injections) being 13.2 months. Overall, their preoperative Andrews-Carson score was 160.3, while their postoperative score was 195. The average patient age was 46 years, with a range of 27 to 73 years.
Except for the percutaneous group, which had significantly less conservative treatment and higher preoperative Andrews-Carson scores than the other two groups, there were no significant differences among the groups regarding any of these variables: age, sex, left or right arm dominance, conservative measures tried, cortisone injections, recurrences, complications, failures, visual analog scores (VAS), and postoperative Andrews-Carson scores. "Each procedure has its advantages and disadvantages," Dr. Szabo said. "But all three did equally well."
Dr. Savoie explained the difference in the percutaneous group's history. "Almost everyone in the percutaneous group had previously had the procedure and came in to have their other elbow done," he said. "That's a procedure that either works terrifically or doesn't work at all. If we had had more patients in that group, the difference would have been statistically significant."
Dr. Savoie added, "People who have had a percutaneous release demand a percutaneous release, and so that's what we do. But my favorite method is to do it arthroscopically."
Whether one procedure is better than the other has been an open question in the field, explained Claude T. Moorman, MD, director of the Duke Sports Medicine Center in Durham, North Carolina, and moderator of the session at which the data were presented.
"I think the value of this presentation is that neither of those three techniques have been demonstrated to be definitively better than the others," Dr. Moorman told Medscape. "Unfortunately, we didn't get much guidance here because all three worked, and we don't know, still, which one to recommend to our patients."
Dr. Moorman said he knew of no trends toward one procedure or another. "A lot of people use the technique they learned and trained with, and based on this study, any of the three techniques ought to work fine," he said. But he added, "I think the vast majority of patients with this problem respond to nonoperative measures — eccentric training, counterforce bracing, and corticosteroid injection. So I would emphasize that nonoperative treatment is often effective. But if the patient fails nonoperative treatment, we've got three good options for surgical management."