TY - JOUR
T1 - Surgical Techniques and Clinical Outcomes for Medial Epicondylitis
T2 - A Systematic Review
AU - Arevalo, Alfonso
AU - Rao, Somnath
AU - Willier, Donald P.
AU - Schrock, Christopher I.
AU - Erickson, Brandon J.
AU - Jack, Robert A.
AU - Cohen, Steven B.
AU - Ciccotti, Michael G.
N1 - Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: B.J.E. has received consulting fees from Arthrex and DePuy Synthes and research support from Arthrex, DePuy, Linvatec, Smith & Nephew, and Stryker. R.A.J. has received support for education from Liberty Surgical and Smith & Nephew and hospitality payments from Pacira Pharmaceuticals. S.B.C. has received consulting fees from CONMED Linvatec and Zimmer Biomet Holdings and publishing royalties from Slack Inc. M.G.C. has received a grant from DJO and Arthrex and support for education from Liberty Surgical Inc. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Publisher Copyright:
© 2022 The Author(s).
PY - 2023/7
Y1 - 2023/7
N2 - BACKGROUND: Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.PURPOSE/HYPOTHESIS: The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.STUDY DESIGN: Systematic review; Level of evidence, 4.METHODS: Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.RESULTS: Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%.CONCLUSION: This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.
AB - BACKGROUND: Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.PURPOSE/HYPOTHESIS: The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.STUDY DESIGN: Systematic review; Level of evidence, 4.METHODS: Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.RESULTS: Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%.CONCLUSION: This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.
KW - elbow
KW - medial epicondylitis
KW - outcome
KW - surgery
KW - systematic review
KW - technique
KW - Humans
KW - Middle Aged
KW - Elbow Tendinopathy
KW - Male
KW - Athletes
KW - Tendons
KW - Tennis Elbow/surgery
KW - Sports
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U2 - 10.1177/03635465221095565
DO - 10.1177/03635465221095565
M3 - Article
C2 - 35658623
AN - SCOPUS:85131549721
SN - 0363-5465
VL - 51
SP - 2506
EP - 2515
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 9
ER -