Outcomes of arthroscopic lateral epicondylitis release: Should we treat earlier?

Abstract

Background When managed conservatively, lateral epicondylitis often subsides only after considerable time, during which social and occupational activities are severely disrupted. If conservative management fails, a recently introduced option is arthroscopic release of the extensor carpi radialis brevis (ECRB). The primary objective of this study was to compare clinical outcomes of this procedure according to preoperative symptom duration. Hypothesis Earlier arthroscopic release is associated with better functional outcomes. Material and method Consecutive patients with arthroscopically managed lateral epicondylitis were included in a retrospective study. Arthroscopy was performed only after at least 6 months of conservative treatment. The criteria to evaluate the clinical outcomes were the Nirschl and Quick-DASH scores, muscle strength, time to pain relief, and percentage of functional recovery. Result Thirty-five patients were evaluated at a median of 4 years (range: 1–12 years) after surgery. Mean preoperative symptom duration was 18 months (range: 6–106 months) with a mean sick leave duration of 2.3 ± 4.9 months. Postoperatively, mean time to recovery was 37.5 days (range: 7 days to 5 years) and mean sick leave duration was 2.4 ± 2.4 months. The mean Quick-DASH score was 15.9 ± 19.1. The Nirschl score improved significantly, from 26.4 ± 7.9 to 66.3 ± 16.3. The initial muscle strength deficit was 10.1 ± 33.2% and muscle strength at last follow-up was increased by 4.3 ± 30.3%. Symptom duration showed no correlations with any of the clinical outcome measures. Discussion and conclusions Outcomes after arthroscopic release were not associated with symptom duration in this study. Nevertheless, the good clinical outcomes support treatment with arthroscopic release after only 6 months of conservative management. Level of evidence IV, retrospective study.