gms | German Medical Science

Objective: Epicondylitis is a frequent problem within the working population. Most of the patients get well with a multi-modal conservative treatment. Only about 10 % stay symptomatic after 1-2 years. These Patient get operated with some kind of surgery concerning the common extensor origin. We use the CRAP-classification and ADORE-algorithm for treating these patients. This study shows the short-term results.

Methods: We tried to combine clinical and radiographic findings in our chronic elbow-pain patients and try to find out which patients need an and especially which operative treatment.

We classify the MRI-Findings on the common extensor origin (CEO) and the lateral ligament-complex (LCL, LUCL) into 3 subgroups:

A no or only little tendinopathic alterations, B partial lesion of the CEO and C nearly or complete lesion oft he CEO and the LCL-complex. D for iatrogenic lesion e.g. after CEO-release (revision cases).

The MRI findings are combined with the clinical stability findings, type 1 no instability, 2 mild instability/Apprehension; 3 complete instability.

Also we add a + if there are intraarticular lesions which seem to trigger extensor activity and therefore mimic a classical Epicondylitis. So we can get out of each lesion a kind of specification as for example B2+ and with this classification can decide via an algorithm if or which operation is needed.

The algorithm what to do on which classification is based on the personal experience in our clinic, doing ellbow surgery for 10 years with LUCL reconstruction.

We defined 3 possible procedures treating the chronic, not responding epicondylits :

All procedures start with an arthroscopy and the treatment oft he intraarticular lesions (e.g. Plica, chondral lesions,..) and testing of the PLRI.

ADORE 1: Extensor release, debridement and Refixation.

ADORE 2: Extensor and LUCL relase and shortening refixation

ADORE 3: Extensor debridement and additional triceps-Transplant for recreating postero-lateral stability.

Results: From 7/2012 to 7/2013 we operated 89 Patients with chronic Epicondylitis according to our algorithm. We assessed Pre, 12 weeks and 1 year scores (Oxford ellbow score, VAS, (own) subjectiv ellbow score)) the ROM and the patients satisfaction.

Staying to our classification 14 Patients had an A3+lesion (hyperlaxity), 5 Patients had an B1+, 30 patients had an B2/3+ and 40 Patients an C/D3+lesion.

The overal OES pre-operatively was 22,1 points. At 52 weeks it was 44,3 (max 48) Within our own subjective score we started with 40,4 and ended up at 82,3 points after one year. VAS could be lowered significantly in all patients. 95 % (85) of the patients gained normal ROM within 12 weeks. All patients but one were satisfied with the operation.

Complications: 1 re-rupture after an pedestrian vs car accident, 3 transient parästhesia (according to the tourniquet time).

Conclusion: The CRAP-Classification and the ADORE Algorithm are on clinical base a good instrument for deciding and treating chronic radial ellbow pain.