Article
A Novel Technique for the Surgical Management of Chronic Lateral Epicondylitis
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Authors
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Abhijeet Wahegaonkar
- Sancheti Institute for Orthopedics & Rehabilitation, Jehangir Hospital, Pune, India
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Sahil Sanghavi
- Sancheti Institute for Orthopedics & Rehabilitation, Pune, India
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Satish Mane
- The Hand Surgery Clinics, Sahyadri Hospital, Pune, India
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Anup Bansode
- The Hand Surgery Clinics, Sahyadri Hospital, Pune, India
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Chaitanya Karande Patil
- The Hand Surgery Clinics, Sahyadri Hospital, Pune, India
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Lateral epicondylitis is usually self-limiting and resolves within 8-12 months. Once it resolves, recurrence is rare. Conservative management remains the mainstay of treatment. When conservative treatment fails, surgery is required for resistant cases. Morrey had put forth three categories of failure following surgical management of chronic lateral epicondylitis. Type 1 failure occurs when an inaccurate initial diagnosis is made or when a concomitant diagnosis is present which contributes to the pathology. Type 2 failure results from inadequate debridement of the pathological tissue from the common extensor origin. Type 3 failures are iatrogenic in nature.
We describe a novel technique to address the confounding factors-which includes decompression of the PIN, arthrotomy, plica / synovial excision, multiple drill holes in the lateral epicondyle, tendon debridement and offloading the tendon by reattaching it approximately 1 cm distal to its actual origin.
Methods: We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated at our Institute from 2013 to 2015 with a minimum 2 years follow up.
Results and Conclusions: All patients had a minimum of 12 months conservative treatment before surgery. The right side was involved in 10 patients and the left side in 4 patients. There were 9 males and 5 females. The mean age was 46.21 years (range 38-56 years). Mean duration of pre-operative symptoms was 23.07 months and the mean follow up period was 31.07 months (range 24-41 months). The average post-operative VAS score reduced to 1.35 (range 0-6) from the average pre-operative VAS score of 7.79 (range 6-10). Our patients recovered 85% of grip strength on the operated side as compared to the opposite side. 12 of the 14 patients (85.7%) in our series had good to excellent functional outcomes on the Mayo Elbow Performance Index.
Our novel technique simultaneously tackles all components of the disease with decreased incidence of surgical failure.
It addresses the tendon, intra-articular pathology and decompression of the PIN provides additional benefit.
This technique can therefore be recommended for wider surgical use, however, prospective randomized studies with a longer follow-up would add further evidence about the effectiveness of our technique.
