Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as lateral epicondylitis. In this regard, authors have combined the atelocollagen injection in the debridement surgery of ME. The purpose of study was to compare clinical outcomes between simple debridement and debridement combined with atelocollagen injection in the ME.

Twenty-five patients with refractory ME and underwent surgical debridement were included in the study. Group A (n=13) was treated with isolated debridement surgery, and group B (n=12) was treated with debridement combined with 1.0 mL of type I atelocollagen. Pain and functional improvements were assessed using visual analogue scale, Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scale respectively before surgery, at 3, 6 months after surgery and at the final follow-up.

Demographic data did not show significant difference between two groups before surgical procedures. Both groups showed improvement in pain and functional score postoperatively. However, at the 3 months after surgery, group B showed significantly better improvement as compared to group A(VAS 3.1 / 2.0, MEPS 71/82 qDASH 29/23). At the 6 months after surgery and final follow-up, both groups did not show any difference.

Surgical debridement combined with atelocollagen is effective treatment option in refractory ME and showed better short-term outcomes compared to isolated surgery.

Recently, several preliminary reports have been issued on the application of computer assistance to bone tumour surgery. Surgical navigation systems can apply three-dimensional images such as CT and MR images to intraoperative visualization. Although CT is better at describing cortical bone status, MRI is considered the best method for defining the extent of marrow involvement for bone tumours and for planning surgical resection in bone tumour surgery. There have been a few reports on the application of MR imaging to navigation-assisted bone tumour surgery through CT–MR image fusion. However, the CT–MRI fusion technique requires additional costs and exposure of the patient to radiation from the preoperative CT, as well as additional time for image fusion. Above all, the image fusion process is a kind of registration (image to image registration) that inevitably leads to registration error. Herein we describe a new method for the direct application of MR images to navigation-assisted bone tumour surgery as an alternative to CT–MRI fusion.

Six patients with an orthopaedic malignancy were employed for this method during navigation-assisted tumour resection. Resorbable pin placement and rapid 3-dimensional spoiled gradient echo sequences made the direct application of MR images to computer-assisted bone tumour surgery without CT–MR image fusion possible. A paired-point registration technique was employed for patient-image registration in all patients. It took 20 min on average to set up the navigation (range 15 to 25 minutes). The mean registration error was 0.98 mm (range 0.4 to 1.7 mm). On histologic examination, distances from tumours to resection margins were in accord with preoperative plans. Mean duration of follow-up was 25.8 months (range 18 to 32 months). No patient had a local recurrence or distant metastasis at the last follow-up.

Direct patient-to-MRI registration is a very useful method for bone tumour surgery, permitting the application of MR images to intraoperative visualization without any additional costs or exposure of the patient to radiation from the preoperative CT scan.