This is a retrospective review of 21 patients treated with debridement of the common extensor origin without repair. The repair technique included decortication by drilling of the lateral epicondyle. The authors followed their patients for a mean follow-up of 15 months. All patients had persistent symptoms for at least one year and had failed conservative treatment. Diagnosis was confirmed with a local injection. The surgical procedure consisted of splitting of the extensor carpi radialis longus and exposure of the extensor carpi radialis brevis. They noted that the ECRB tendon was almost entirely detached at its origin. Distal retraction of more than 1 cm was not observed. They made no effort to repair the extensor carpi radialis brevis. Surgical technique consisted of creating 4-5 drill holes (2 mm in diameter) at the anterior aspect of the lateral epicondyle. The extensor longus was repaired. Results indicated that at 3-6 weeks post-operatively, 57% still had pain. At 16 month follow-up, 81% had no pain or mild pain. Eighteen of 21 patients were satisfied and would undergo the procedure again.
This is another article suggesting an alternative surgical procedure for recalcitrant epicondylitis at the elbow. In this series, post-operative recovery was slow and painful, and was characterized by a prolonged inability to work. The authors note the remarkable longevity of symptoms and impairment even in patients who improved. This from a condition with relatively minor pathology and a surgery with limited morbidity. The authors note in the discussion that they no longer drill the epicondyle and believe that this leads to a faster recovery. It has been over 100 years since epicondylitis was first described in the medical literature. Our understanding of this, the most common condition afflicting the elbow, remains limited and our treatment methods relatively unscientific.
Journal of Shoulder and Elbow Surgery