275. ENDOSCOPIC TREATMENT OF ELBOW EPICONDYLALGIA: LONG-TERM FOLLOW-UP

Abstract

Purpose of the study: The purpose of this paper was to report our experience with arthroscopic treatment of tendon-related epicondylalgia resistant to well-conducted medical treatment and the long-term outcomes. From September 2000 to January 2008, 25 consecutive patients underwent arthroscopic treatment performed by the same surgeon. Twenty-two patients were available for follow-up. We reviewed 26 interventions.

Material and methods: An endoarticular technique was used, with section of the lateral capsule then the extensor carpi radialis brevis and the extensor digitorum communis. Mean patient age was 45 years (36–55); five patients had work accidents (one bilateral case). Patients were assessed clinically using the Mayo Clinic Elbow Performance Score (MEPS) and for pain at rest, during daily life activities and during exercise (scale 0–10).

Results: Mean follow-up was 51 months (17.6–88.7). Pain was scored 0.38 at rest, 0.81 for daily life activities, and 4.11 for exercise. Mean function score was 90/100. Two patients underwent revision. Sixteen patients (62%) stated they were « much better », six « better » (23%) and four unchanged (15%). Twenty-one patients (81%) were satisfied, 23 would request the same procedure (88%). There was no statistically significant difference in the subgroup of work accidents versus the other patients with p=1.35 for pain at rest; p=0.51 for pain during daily life activities, p=0.37 for pain during exercise. Two minor complications (skin burn, subcutaneous infection) were observed.

Discussion: The results show improvement postoperatively. Patient satisfaction was correlated with the clinical results and the function score. Treatment of resistant epicondylalgia remains a very controversial issue; several surgical techniques have been described with good or even excellent results. Arthroscopic treatment, inspired by the work of Kuklo, was adopted by Baker, Owens and Jerosch. Our results are equivalent to those of other arthroscopy series. Longer time before resumption of occupational activities can be explain in our opinion by the greater number of patients with an occupational accident in our series.

Conclusion: Arthroscopic resection yields satisfactory results which are sustained over time, for the treatment of resistant epicondylalgia. It is an alternative to open surgery.