Arthroscopic ECRB release with Decortication tied to better functional outcomes in recalcitrant lateral epicondylitis

A study by Tarun Goyal et al showed favourable functional outcomes and pain scores of ARD compared to continued intensive conservative treatment for RLE.

A prospective, non-randomized, interventional study was conducted comparing pain scores and functional outcomes between arthroscopic extensor carpi radialis brevis release and continued intensive conservative treatment. The study has been published in Indian Journal of orthopedics.

Inclusion criteria were patients between 20 and 60 years of age, with pain and tenderness localized at the common extensor origin (CEO), a positive cozens test, duration of symptoms of at least 6 months, and with failed conservative treatment including local infltrations of steroid injections up to 2–3 times. Any patients with systemic polyarthritis, fbromyalgia, cervical radiculopathy, and any previous history of injury or surgery in the elbow which may interfere with the outcome analysis were excluded from the study.

The study compared two groups:

Group 1, consisting of 25 patients undergoing continued conservative treatment for 24 months, and

Group 2, consisting of 25 patients undergoing arthroscopic extensor carpi radialis brevis release with decortication (ARD).

VAS (Visual Analogue Scale) score for lateral elbow pain at rest and after routine daily activities were compared at 6 weeks, 24 weeks, 12 months and 24 months. Functional outcomes were compared with grip strength, and patients reported functional outcome scores, pre-intervention and 24 months post-intervention.

The results of the study were:

• There was a significant improvement in VAS scores for pain, functional outcome scores, and grip strength in both the groups post-intervention (P< 0.05).

• VAS scores for pain at rest in both the groups were significantly better after the interventions, at all follow-up durations (P<0.001).

• VAS scores for pain after routine daily activities were significantly better in group 2 at 24 weeks (P=0.002) and afterward (P< 0.001).

• Group 2 had significantly better functional outcome scores at 24 months (P < 0.001) though the difference in grip strength was not statistically significant (P=0.121).

The authors concluded that - The current study supports arthroscopic surgery for RLE compared to continued intensive nonoperative treatment. ARD results in better functional outcomes and pain scores compared to no surgical intervention. Studies with longer follow-up may be warranted to compare these two methods over time.

Level of Study II - Non-randomized comparative study.

Further reading:

Outcomes of Continued Intensive Conservative Treatment Versus Arthroscopic Extensor Carpi Radialis Brevis Release for Recalcitrant Lateral Epicondylitis: A Non randomized Controlled Trial

Tarun Goyal, Arghya Kundu Choudhury et al

Indian Journal of Orthopaedics (2022) 56:1578–1586

https://doi.org/10.1007/s43465-022-00649-w