Arthroscopic Treatment of Combined Lateral Epicondylitis and Posterolateral Rotatory Instability of the Elbow (SS-51)

ABSTRACTS scores of 100 and rated their elbow as “normal” or “almost normal” on the SOD scale. Conclusion: Retrograde drilling of capitellar OCD lesions resulted in successful healing of five out of five patients in this case series. This technique is a safe and reasonable treatment option to stimulate healing of the subchondral bone without disruption of the articular cartilage. Further study of the optimal surgical technique and long-term outcome is required but the initial results of retrograde drilling for OCD lesions of the capitellum are encouraging. Arthroscopic Treatment of Combined Lateral Epicondylitis and Posterolateral Rotatory Instability of the Elbow (SS-51) Sergey S. Dzugan, M.D., Felix H. Savoie III, M.D., Larry D. Field, M.D., Michael J. O’Brien, M.D. Introduction: Lateral elbow pain has multiple etiologies with the most common being lateral epicondylitis (tennis elbow). Other entities that may produce pain in this area include radio-capitellar arthritis, posterolateral rotatory instability (PLRI), plica syndrome, and radial tunnel syndrome. We report on a rare subset of patients who have chronic lateral epicondylitis and then sustain an acute injury that produces instability in addition to the epicondylitis. Attempted nonoperative management was unsuccessful and all patients required surgical repair of both injuries for a successful result. Our hypothesis is that there is a subset of active patients with preexisting lateral epicondylitis who sustain an additional acute injury that extends the damage to include some or all of the radial ulnohumeral ligament complex. These patients develop persistent symptoms of both epicondylitis and instability which, if unrecognized, will lead to failure of surgical management if only the lateral epicondylitis is repaired. Methods: A retrospective review of 163 elbow arthroscopies over the past 3 years performed by the senior author revealed seven patients with a diagnosis of combined lateral epicondylitis and lateral elbow instability determined by history, physical examination, and MRI testing. Five patients were heavy laborers, one recreational tennis player, and one insurance agent. The data, including Andrews-Carson scores, was collected prospectively in the initial evaluation and at regular postoperative intervals. The patient age range was 29 to 46 (average 40.7 years); all were right-hand-dominant elbows. The follow-up range was from 6 to 18 months. Two patients had previous lateral epicondylitis repair that failed and one had previous ulnar nerve transposition

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that did not resolve the symptoms. The four other patients had nonoperative measures including injections, medications, physical therapy and bracing prior to surgery. The indications for surgery were pain, functional impairment, and a failure of nonoperative or operative treatment. All surgeries were performed on an outpatient basis under general anesthesia in the prone position. Surgical findings included extensor carpi radialis brevis (ECRB) avulsion in two patients and ECRB tear in five patients. Six patients had radial ulnohumeral ligament (RUHL) and/or lateral collateral ligament (LCL) tear, and one patient had a complete RUHL avulsion. Two patients had Baker Type 3 lesion and five patients had Baker Type 2 lesion. Results: Six out of seven patients managed solely via arthroscopic means had significant (p⬍0.05) improvement in total Andrews-Carson score. All patients exhibited full range of motion and objective improvement in strength and function as measured by an independent physical therapist. The remaining patient, a revision workers’ compensation heavy duty mechanic, exhibited objective improvement in all parameters but subjectively still felt unable to return to regular duty. Conclusion: A combined injury pattern of lateral epicondylitis and lateral elbow instability is an important and rare subset of patients who frequently go misdiagnosed as tennis elbow only without recognition of instability. This study is the first case series of patients to date with these combined injuries treated primarily arthroscopically. Surgical correction of both injuries resulted in satisfactory results in a majority of patients. Arthroscopic Treatment for Limitation of Motion of the Elbow: Our Learning Curve in a Series of 120 Cases (SS-52) Hee-Don Han, M.D., Sung-Jae Kim, M.D., Yong-Min Chun, M.D., Sung-Hwan Kim, M.D., Sung-Guk Kim, M.D., Hong-Kyo Moon, M.D. Introduction: The aim of this study was to demonstrate our learning curve in arthroscopic treatment for limitation of motion of the elbow. Methods: To verify the surrogates for learning curve, operative time and motion improvement in 120 consecutive elbows were plotted by case number and the learning curve was illustrated by the best-fit curve. The study population was divided into eight consecutive blocks (15 cases per block). Mean operative time and motion improvement in each block were compared. Once the surrogate for learning curve and its affecting factors had been identified, multiple regression analysis was carried out.