Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis

Abstract

Background: Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques.

Hypothesis: Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up.

Study design: Case series; Level of evidence, 4.

Methods: Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1 surgeon between 1991 and 1994 were retrospectively reviewed. Eighty-three patients (92 elbows) were available by telephone for a mean follow-up of 12.6 years (range, 10-14 years). Outcome measures included the Numeric Pain Intensity Scale, Nirschl and Verhaar tennis elbow-specific scoring systems, and American Shoulder and Elbow Surgeons elbow form. Preoperative data were collected retrospectively.

Results: The mean age of the study group was 46 years (range, 23-70 years) with 45 men and 38 women. Eighty-seven of the procedures were primary, and 5 were revision tennis elbow surgeries. Concomitant procedures were performed in 30 patients including ulnar nerve release in 24 patients, medial tennis elbow procedures in 23 patients, shoulder arthroscopy in 2 patients, carpal tunnel release in 1 patient, and triceps debridement and osteophyte excision in 1 patient. The mean duration of preoperative symptoms was 2.2 years (range, 2 months to 10 years). The mean Nirschl tennis elbow score improved from 23.0 to 71.0, and the mean American Shoulder and Elbow Surgeons score improved from 34.3 to 87.7 at a minimum of 10-year follow-up (P < .05). The Numeric Pain Intensity Scale pain score improved from 8.4 preoperatively to 2.1 (P < .05). Results were rated as excellent in 71 elbows, good in 6 elbows, fair in 9 elbows, and poor in 6 elbows by the Nirschl tennis elbow score. By the criteria of Verhaar et al, the results were excellent in 45 elbows, good in 32 elbows, fair in 8 elbows, and poor in 7 elbows. Eighty-four percent good to excellent results were achieved using both scoring systems. Ninety-two percent of the patients reported normal elbow range of motion. The overall improvement rate was 97%. Patient satisfaction averaged 8.9 of 10. Ninety-three percent of those available at a minimum of 10-year follow-up reported returning to their sports.

Conclusion: The mini-open Nirschl surgical technique with accurate resection of the tendinosis tissue remains highly successful in the long term.