Arthroscopic Versus Open Lateral Release for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Trial.

PURPOSE: The purpose of this randomized clinical trial was to determine whether quality of life and function, as measured using subjective questionnaires and clinical assessment, are different after open versus arthroscopic debridement of the pathologic extensor carpi radialis brevis origin in the treatment of lateral epicondylitis at 1 year postoperatively.

METHODS

Patients older than 16 years with a minimum of 6 months of nonoperative management for lateral epicondylitis were recruited into this prospective, single-blinded randomized clinical trial. Patients were randomized intraoperatively to undergo open or arthroscopic release. Scores on the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure; visual analog scale (VAS); and Patient-Rated Tennis Elbow Evaluation (PRTEE) were recorded preoperatively and 3, 6, and 12 months postoperatively. Grip strength was assessed by an independent assessor. All patients followed the same physiotherapy regimen.

RESULTS

Between 2002 and 2014, we randomized 37 patients to the open technique and 38 to the arthroscopic technique. Both groups improved significantly from preoperatively to 12 months postoperatively (P < .001). There were no significant differences between the 2 groups when comparing the DASH score, VAS score, PRTEE score, or grip strength at any time point. The only significant difference between study groups was that the arthroscopic technique resulted in a longer surgery time: 34.0 minutes (standard error of the mean, 2.9 minutes) versus 22.5 minutes (standard error of the mean, 1.3 minutes) (P = .005).

CONCLUSIONS

Comparing the open versus arthroscopic technique in the surgical management of lateral epicondylitis through a randomized clinical trial, we determined that there was no difference between the 2 operative modalities when examining the DASH score, VAS score, PRTEE score, grip strength, or complication rate at 12 months postoperatively. A shorter operative time coupled with potentially less setup time may favor open release.

LEVEL OF EVIDENCE: Level II, lower-quality randomized trial.