gms | German Medical Science

Objectives/Interrogation: Historically, attempts to surgically treat recalcitrant lateral epicondylitis have been associated with significant post-operative pain and a prolonged period of dysfunction. The authors have hypothesized that use of a minimally invasive radiofrequency coblation technique & arthroscopic synovectomy can provide enhanced early pain relief as compared to prior techniques.

Methods: The authors have prospectively evaluated 35 patients surgically managed with radiofrequency coblation of the lateral epicondylar tendon insertion and arthroscopy with synovectomy of a synovial "plica" when noted.

Thirty patients have been followed for a minimum of two years and up to five years. All patients were treated conservatively pre-operatively for a minimum of six months. In all cases, symptoms were present for a minimum of eight months and in some, up to four years. Pre-operatively patients rated their level of pain on a visual analog scale a mean of 8.6. Twenty-eight patients were found to have radiocapitellar synovitis which was arthroscopically resected. All patients were treated with the Topaz (ArthroCare, Sunnyvale, CA) Radiofrequency Coblation instrument. Perforations were made at 5 mm intervals over a 3.5 x 2.5 cm grid at the denervated insertion of the extensor musculature along the lateral epicondylar ridge.

Results and Conclusions: Twenty-eight of thirty-five patients were found to have an inflamed synovial plica with erosive changes of the radial head. Post-operative pain ratings on the first day post-operatively averaged 6.3, by the second week 4.8, by six weeks 3.8, by 12 weeks 2.7, by six months 1, and by 12 months 0.9. Twenty-nine returned to pre-injury activities and sports by 12 weeks. Six patients stated that they have not returned to their pre-injury level of function and have had incomplete pain relief. All six of those patients were Workers Compensation patient who had other outstanding Workers' Compensation claims, but five said that they were substantially improved and would go through the surgery again.

Radiofrequency coblation has been shown in areas of tendinosis to enhance neovascularization in the area of treatment. Radiofrequency coblation along the lateral epicondylar ridge in conjunction with an arthroscopic synovectomy appears to enhance healing while minimizing post-operative pain experience, thus allowing a rapid return to functional activities.