Summary

Arthroscopic ECRB debridement for chronic lateral epicondylopathy is associated with good to excellent functional outcomes and successful return to sport with low failure rate in the short- to mid-term follow up.

Abstract

Objective

This study aimed to evaluate the short- to mid-term clinical outcomes following arthroscopic extensor carpi radialis brevis (ECRB) debridement in patients with chronic lateral epicondylopathy. We hypothesized that arthroscopic ECRB debridement results in favorable short to mid-term clinical results.

Material And Methods

A retrospective case series of patients who underwent arthroscopic ECRB debridement was conducted. At a minimum follow-up of 12 months postoperatively, functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Visual Analog Scale (VAS) for pain. Comparison of pre- versus postoperative functional outcomes were utilized with DASH and VAS scores. Maximum isometric strength test for wrist extension and postoperative range of motion (ROM) were determined for both, healthy and operated elbow joints at follow up. Data distribution was evaluated with the Kolmogorov-Smirnoff test and Group comparisons were performed using the paired-t-test or Wilcoxon signed-rank test. Level of significance was set at p < 0.05.

Results

Of 33 patients who were eligible for this study, a total of 28 patients were assessed at follow-up (85% follow-up; mean age 48.4 ± 6.6 years; min: 36; max: 65 years; 43% male). Mean duration of symptoms was 12,0 months (IQR 8 - 20 range: 56). The follow-up time was 30.5 months (IQR 19.25–39.75, range: 33). The following outcome results were obtained: MEPS 98.75 (IQR 85–100;range 15); DASH 9.97 (IQR 0.8–15.4; range 39,2); VAS 1.63 (IQR 1–2, range 4), PRTEE 14.79 (IQR: 1.4 -26.1, range: 43). 21 patients were preoperatively assessed with VAS and DASH. In this group, there were significant improvements from pre- to post-operative scores for VAS (7 (IQR 4-7.7; range 7) vs. 1.75 (IQR 1-2, range: 4); p <0.01) and DASH 46.5 (IQR 27.2 - 64.5, range 69) vs. 10.38 (IQR 0.8 - 15.8; range 39.2); p <0.01). The mean strength of wrist extension compared to the healthy side was 99.7% (range 69,5–121,4%), with no significant difference between both sides. There was no significant difference in ROM compared to the healthy side. One patient was diagnosed with posterolateral rotational instability 6 months after initial surgery and therefore treated with lateral ulnar collateral ligament (LUCL) reconstruction using an ipsilateral triceps tendon graft (clinical failure rate 3.5%). Overall, 75% of patients returned to their normal sporting activities at the same or slightly reduced level, 13% of patients reached a higher level of sports activity. 84% of patients would be willing to undergo the procedure again.

Conclusion

Arthroscopic ECRB debridement for chronic lateral epicondylopathy is associated with good to excellent functional outcomes and successful return to sport with low failure rate in the short- to mid-term follow up.