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Editorial Commentary: Elbow Lateral Epicondylitis (Tennis Elbow) Surgery Works, but Is Not Often Indicated
Editorial Commentary: Elbow Lateral Epicondylitis (Tennis Elbow) Surgery Works, but Is Not Often Indicated Gary G. Poehling, M.D., Editor-in-Chief Emeritus
Abstract: In the small percentage of patients who do not respond to nonoperative approaches to tennis elbow, surgerydwhether it is open, arthroscopic, or percutaneousdprovides near 90% satisfaction rates.
See related article on page 1260
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cillia and Pierce, with their team of co-authors, Issa, Gilbert, Hanley, Festa, and McInerney from Seton Hall, have produced an excellent systematic review of tennis elbow surgery, “A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin.”1 To best interpret this work, we need to realize that “no treatments, invasive or noninvasive have been proven to alter the natural history of the condition.”2 In an epidemiology study at Mayo Clinic, the authors found that in a 10% random sample of 5,760 patients, the condition in 74% (427) resolved within 3 months without surgery. They found that 2.2% (13) patients in the sample ultimately required surgery.3 The message here is that tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment we use. This systematic review does demonstrate that for those patients in whom the condition does not resolve with conservative treatments, surgical treatment can be effective. The patient
satisfaction rates of 94% for open, 89% for arthroscopic, and 88% for the percutaneous technique are not statistically different and are encouraging for the small group of patients who require surgery. Each of the techniques has advantages and disadvantages that allow us to use what is most comfortable in our hands.
References 1. Pierce TP, Issa K, Gilbert BT, et al. A systematic review of tennis elbow surgery: Open versus arthroscopic versus percutaneous release of the common extensor origin. Arthroscopy 2017;33:1260-1268. 2. Drake ML, Ring DC. Enthesopathy of the extensor carbi radialis brevis origin: Effective communication strategies. J Am Acad Orthop Surg 2016;24:365-369. 3. Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidermiology and health care burden of tennis elbow. Am J Sports Med 2015;43: 1066-1071.
Ó 2017 Published by Elsevier on behalf of the Arthroscopy Association of North America 0749-8063/17234/$36.00 http://dx.doi.org/10.1016/j.arthro.2017.02.020
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 33, No 6 (June), 2017: p 1269
1269
Abstract: In the small percentage of patients who do not respond to nonoperative approaches to tennis elbow, surgerydwhether it is open, arthroscopic, or percutaneousdprovides near 90% satisfaction rates.
See related article on page 1260
S
cillia and Pierce, with their team of co-authors, Issa, Gilbert, Hanley, Festa, and McInerney from Seton Hall, have produced an excellent systematic review of tennis elbow surgery, “A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin.”1 To best interpret this work, we need to realize that “no treatments, invasive or noninvasive have been proven to alter the natural history of the condition.”2 In an epidemiology study at Mayo Clinic, the authors found that in a 10% random sample of 5,760 patients, the condition in 74% (427) resolved within 3 months without surgery. They found that 2.2% (13) patients in the sample ultimately required surgery.3 The message here is that tennis elbow is a common problem that resolves by 6 months in most cases no matter what treatment we use. This systematic review does demonstrate that for those patients in whom the condition does not resolve with conservative treatments, surgical treatment can be effective. The patient
satisfaction rates of 94% for open, 89% for arthroscopic, and 88% for the percutaneous technique are not statistically different and are encouraging for the small group of patients who require surgery. Each of the techniques has advantages and disadvantages that allow us to use what is most comfortable in our hands.
References 1. Pierce TP, Issa K, Gilbert BT, et al. A systematic review of tennis elbow surgery: Open versus arthroscopic versus percutaneous release of the common extensor origin. Arthroscopy 2017;33:1260-1268. 2. Drake ML, Ring DC. Enthesopathy of the extensor carbi radialis brevis origin: Effective communication strategies. J Am Acad Orthop Surg 2016;24:365-369. 3. Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidermiology and health care burden of tennis elbow. Am J Sports Med 2015;43: 1066-1071.
Ó 2017 Published by Elsevier on behalf of the Arthroscopy Association of North America 0749-8063/17234/$36.00 http://dx.doi.org/10.1016/j.arthro.2017.02.020
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 33, No 6 (June), 2017: p 1269
1269