Recalcitrant Lateral Epicondylitis: Open and Arthroscopic Release

Young-Kyu Kim; Jong-Hun Lee; Ji-Hoon Kwak; Sung-Hoon Moon

doi:10.4055/jkoa.2008.43.3.366

Journal List > J Korean Orthop Assoc > v.43(3) > 1012794

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Kim, Lee, Kwak, and Moon: Recalcitrant Lateral Epicondylitis: Open and Arthroscopic Release

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(3): 366-373.

Published online: 30 June 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.3.366

Recalcitrant Lateral Epicondylitis: Open and Arthroscopic Release

Young-Kyu Kim, M.D., Jong-Hun Lee, M.D., Ji-Hoon Kwak, M.D., Sung-Hoon Moon, M.D.

Department of Orthopedic Surgery, Gil Medical Center, Gachon University, Inchon, Korea.

Address reprint requests to Young-Kyu Kim, M.D. Department of Orthopedic Surgery, Gil Medical Center, Gachon University, 1198, Guwol-dong, Namdong-gu, Inchon 405-760, Korea. Tel: +82.32-460-3384, Fax: +82.32-468-5437, kykhyr@gilhospital.com

Abstract

Purpose

To compare clinical outcomes when using open or arthroscopic release for recalcitrantlateral epicondylitis.

Materials and Methods

A total of 34 cases were followed up for an average of 16 months. Open release was performed in 21, and arthroscopic release in 13. In the open release group, arthroscopic examination was performed first in 7. Intraarticular and extraarticular lesions of the extensor tendon were compared. Pain was evaluated using the Visual Analog Scale, and function was evaluated using the assessment of Nirschl and Pettrone.

Results

In arthroscopic findings, 6 out of 20 cases were nearly normal, 6 showed fraying, 4 a linear tear, and 4 avulsion. Some (3 of 5) cases with nearly normal arthroscopic findings had mucinoid degeneration detected during the open procedure. Overall, 86% of open release and 85% of arthroscopic release showed satisfactory results.

Conclusion

The extraarticular and intraarticular surfaces of the extensor origin had diverse appearances, and both procedures showed satisfactory results. Therefore, arthroscopic release is a useful treatment option for recalcitrant lateral epicondylitis.

Keywords: Elbow, Recalcitrant lateral epicondylitis, Open and arthroscopic release

Figures and Tables

Fig. 1

Open procedure for recalcitrant lateral epicondylitis. (A) Pathologic tissue with mucinoid degeneration and the avulsion rupture of the extensor brevis origin (arrow) is carefully identified and resected. (B) The lateral epicondyle (arrow) is then drilled to enhance revascularization of the area.

Fig. 2

Arthroscopic procedure for recalcitrant lateral epicondylitis. (A) The origin of the extensor brevis tendon is released arthroscopically. (B) Then, decortication of the lateral epicondyle is performed.

Fig. 3

Gross findings of extraarticular pathology of the extensor carpi radialis brevis tendon were classified into three types: (A) Mucinoid degeneration of the tendon with discolored tissue (type I), (B) Partial tear of the tendon (type II), (C) Complete tear of the tendon (type III).

Fig. 4

Lesions on the undersurface of the extensor carpi radialis brevis tendon were classified using to the classification system proposed by Baker. (A) Fraying of the undersurface of the tendon without torn capsule (type I), (B) Linear tear in the capsule and tendon (type II), (C) Partial avulsion of the tendon (type IIIa), (D) Complete avulsion of the tendon (type IIIb).

Table 1

Findings of Lesions in the Extensor Carpi Radialis Brevis Tendon

Table 2

Intra- and Extra-articular Findings in Cases Converted to an Open Procedure

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