Many procedures have been described for the operative treatment of tennis elbow (lateral epicondylitis). Arthroscopic release is a relatively recent development. The aim of this study was to review our early results of arthroscopic tennis elbow release. This was a prospective study of 28 consecutive patients with tennis elbow refractory to conservative management, who underwent arthroscopic tennis elbow release performed by one surgeon. At surgery, arthroscopic joint assessment was performed followed by capsulectomy and debridement of the Extensor Carpi Radialis Brevis (ECRB) tendon origin using the proximal lateral and medial portals. The ECRB lesions were classified and resected with a shaver but the insertion site was not decorticated. Patients were assessed preoperatively, at 2 weeks and 3 months using the DASH score. Of the 28 elbows 21 were noted to have a Nirschl type I lesion (intact capsule), 6 had a type II lesion (linear capsular tear) and 1 a type III (capsular rent). Degenerative articular changes were noted in 19 elbows. If arthroscopic debridement was required it was undertaken. Three elbows were noted to have eccentric radial heads. Radial plicae which were impinging on the radial head were noted in three patients. 1 patient was lost to follow up. There was a significant improvement in DASH scores (p<
0.002) at 2 weeks post operatively. This improvement was sustained at 3 months. This is a worst case scenario analysis using a paired t test. 1 patient had post operative stiffness and 6 failed to improve of which 2 were revisions. The early results would suggest arthroscopic tennis elbow release is an effective treatment for tennis elbow, which in addition also allows assessment of the elbow joint and the potential to address associated intra-articular pathology. This minimally invasive technique has been demonstrated to be safe and affords early post operative rehabilitation.
Many procedures have been described for the operative treatment of tennis elbow (lateral epicondylitis). Arthroscopic tennis elbow release is a relatively recent development. The aim of this study was to review our early results of arthroscopic tennis elbow release. This was a prospective study of 29 consecutive patients (30 elbows) with tennis elbow refractory to conservative management, who underwent arthroscopic tennis elbow release performed by one surgeon. At surgery, arthroscopic assessment of the elbow joint was performed followed by capsulectomy and debridement of the Extensor Carpi Radialis Brevis (ECRB) tendon origin using the proximal lateral, anteromedial and anterolateral portals. Associated intra-articular pathology was noted. The ECRB lesions were classified according to their gross morphology and resected with a shaver but the insertion site was not decorticated. Patients were assessed preoperatively, at 2 weeks and at 3 months using the DASH score. 29 patients with tennis elbow were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 30 elbows undergoing surgery, 22 were noted to have a Nirschl type I lesion (intact capsule), 7 had a type II lesion (linear capsular tear) and 1 had a type 3 lesion (capsular rent). Degenerative articular changes were noted in 18 elbows. Arthroscopic debridement was undertaken if appropriate. Three elbows had eccentric radial heads. Radial plicae which were impinging on the radial head were present in three patients. Mean follow up is 9 months (1–23). 1 patient was lost to follow up. There was a significant improvement in DASH scores (p<
0.05) at 2 weeks post operatively. This improvement became more significant at 3 months post operatively. This is a worst case scenario analysis using a paired t test. 6 patients failed to improve, 1 partially improved and 1 was revised and improved. There were no surgical complications; however, one patient has post operative stiffness which required an arthroscopic release. The early results of this study would suggest arthroscopic tennis elbow release is an effective treatment for tennis elbow, which in addition also allows assessment of the elbow joint and the potential to address associated intra-articular pathology if required. This minimally invasive technique has been demonstrated to be safe and affords early post operative rehabilitation and return to normal activities.
The study objective was to assess if the mechanical properties of Polylactic Acid (PLA) bio-absorbable suture anchors vary with temperature? Bio-absorbable suture anchors may offer advantages over metal anchors. However, their performance at body temperature has been questioned in recent literature (Meyer et al). In particular, constant tension at body temperature caused early failure at the anchor eyelet. Using a previously validated mechanical jig, 15 standard locked sliding arthroscopic knots (Duncan Loop + three alternate hitches) were tied by the senior author using PAN-ALOK anchors (DEPUY MITEK, Edinburgh, UK) and ETHIBOND sutures (ETHICON) and placed under a standard constant tensile load reproducing the action of the surgically repaired rotator cuff. All anchors were loaded for at least five days to match previous studies. Eight were incubated at a constant 37°C and six were kept at room temperature. The elongation of the suture knot/anchor construct was assessed by a rheostat within the mechanical jig. Sample unused, room temperature and body temperature anchors were blindly analysed using plane polarized light microscopy with a graticule to assess deformation, concentrating on the eyelet region. Mean elongation of body temperature anchors = 0.461mm (0.159 – 0.952) Mean elongation of room temperature anchors = 0.278mm (0.159 – 0.793) Unpaired t-test: p=0.24 Microscopic analysis of the anchor material showed no difference in structural deformation in the three anchors. Our model suggests no significant increase in elongation at body temperature for this commonly used arthroscopic suture anchor / knot construct. This counters previous work. It gives us confidence to continue to use such devices.