Arthroscopic Release Of Common Extensor Tendon To Treat Chronic Lateral Epicondylitis (SS-35)

ABSTRACTS Introduction: UCL disruption can be a disabling injury particularly in throwing athletes. The reconstruction as originally described by Jobe, is technically demanding and has a relatively high complication rate. This paper presents a modification reducing the difficulty and morbidity. Type of Study: Retrospective review, case series. Materials and Methods: Between 01/1999 to 12/ 2002, 18 patients were treated with the mini open procedure, 4 patients were lost to follow-up. Average follow-up was 30 months. The surgical technique incorporates a tendon graft fixed through an osseous tunnel placed at the distal humerus and one suture anchor placed into the proximal ulna. All patients received an identical post-operative rehabilitation protocol. A minimum of one year follow-up was required. All patients were male competitive overhead athletes. Conway-Jobe and Mayo Elbow performance scores were used to measure outcomes. In addition, time to return to activity, level of pain with activity, and pitch speed at final follow-up were recorded. Results: 13 of the 14 patients were baseball players (1 Tennis player) and the average age at surgery was 19 years. 12 / 14 had an excellent rating on the ConwayJobe scale, two had a good score. The average Mayo Elbow Performance score was 96 with 12 receiving an excellent, 1 good and one fair. 9 / 12 patients did not have pain with throwing. All patients returned to their respective sport: 7 patients continued to higher levels of play, in addition 4 achieved the professional baseball level. The average time for post-operative full rehabilitation was 11 months with patients throwing an average of 6 days per week. The average preoperative pitch speed of 88 mph improved to an average of 90 mph after surgery. 2 patients did not return to the pre-injury level of play due to pain. No patient demonstrated transient postoperative ulnar neuropraxy. Conclusion: This surgical modification is a viable alternative to the originally described procedure. It minimizes soft tissue dissection and bone tunnels. Our results demonstrate excellent results in 86% of the patients; 50% returned to a higher level of play after surgery, 29 % played at the professional level at final follow-up. Arthroscopic Release Of Common Extensor Tendon To Treat Chronic Lateral Epicondylitis (SS-35). Marco Maiotti, MD, Alessandro Bollanti, MD, Carlo Massoni, MD Lateral epicondylitis is a well documented degenerative overuse tendinopathy which particularly involves extensor carpi radialis brevis (ECRB) tendon and exten-

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sor digitorum communis (EDC) aponeurosis. The majority of surgical procedures designed for its treatment consisted of epicondylar decortication, excision of degenerative lesion with repair of ECRB tendon or common extensor tendon (CET) release. In our case-series study we present the clinical outcome of patients who underwent arthroscopic release of CET for CLE at a mean follow-up of 36 months. We conclude that arthroscopic release of CET may provide an effective alternative for the treatment of sport-related CLE with satisfactory mid-term results. Purpose: To evalue the clinical outcome of arthroscopic release of common extensor tendon (CET) to treat chronic lateral epicondylitis (CLE). Type of Study: Case series. Methods: Twenty-four patients (14 men/10 women) with an average age of 30 years (range 26-48) underwent arthroscopic release of CET for unilateral, sport-related CLE. Exclusionary criteria: failures from previous surgery. Before surgery all patients had participated in a 5 months physical program without success. Arthroscopic release of the CET and the abrasion of its origin were performed respectively by radiofrequency probe and shaver using the proximal medial and lateral portal (Poheling’s technique). Rehabilitation consisted of early active range of motion and gradual return to full activity. The Disability of Arm, Shoulder and Hand (DASH) scoring system was used to assess patients for current activity level as well as activity before surgery. Statistical analysis was performed using the Mann-Whitney U test. Results: No major complications occurred. At mean follow-up of 36 months ( range 24 to 41 months) statistical analysis showed significant improvements in DASH score (p⫽.001). Results were significantly (p ⬍ .05) better when performing arthroscopic release of CET no later than one year after onset of symptoms. Conclusions: Extensor carpi radialis brevis (ECRB) tendon and extensor digitorum communis (EDC) aponeurosis origin represent the primary pathoanatomic area of lateral epicondylitis. Arthroscopic release of CET has been demonstrated to be a valid procedure to treat CLE with satisfactory mid-term results. Longer follow-up is needed to see if these results may change with time in high demand individuals. The Double-Bundle ACL Reconstruction: A Superior Technique to Restore Knee Kinematics (SS-36). Denny Lie, MD, Anthony Bull, MD, Andrew Amis, MD Introduction: Residual tibial internal rotation of about 5° may persist (a ‘mini-pivot’)after ACL recon-