SURGICAL TREATMENT OF RESISTANT LATERAL EPICONDYLITIS: A LONG-TERM FOLLOW-UP

Abstract

Introduction and Aims: Several surgical techniques have been described for the treatment of resistant lateral epicondylitis or tennis elbow with variable results. This retrospective study presents the long-term outcome of a single surgeon’s experience, with a modified surgical technique for the treatment of resistant lateral epicondylitis.

Method: Between 1986 and 2001, the senior author performed 171 surgical procedures in 158 patients for resistant lateral epicondylitis. 147 elbows in 136 patients (88%) were independently evaluated at a mean time to follow-up of 9.8 years. Patients were assessed using a functional questionnaire and physical assessment. In addition to physical assessment, provocative testing of the extensor origin and grip strength was performed. Patients subjectively rated the result of surgery and these results were compared to objective elbow performance scores.

Results: Subjectively, 97% of patients assessed the result from surgery as good to excellent. Objectively, 97% results were good to excellent using elbow performance scores. Synovial fistulae developed in two patients by day 10 post-operatively. One patient required further surgery for a synovial fistula, which healed with no sequelae. There were no other complications following surgery. The post-operative range of motion improved in all patients, but remained reduced in four patients. There was a significantly worse outcome for patients with a Workers’ compensation claim and for cigarette smokers. There was no difference between grip strengths between the operated arm and the non-operated arm. The majority of patients returned to work by six weeks and were pain-free by 12 weeks. Less than 5% of patients experienced lateral epicondylitis pain in their elbow post-operatively. A small group of patients altered their occupation or recreational activities due to tennis elbow symptoms.

Conclusion: The surgical technique described produces excellent results in greater than 87% of patients in the treatment of resistant lateral epicondylitis. This procedure produces a low complication rate and is associated with a high rate of patient satisfaction. Patient selection is critical in the surgical treatment of resistant lateral epicondylitis.