The Boyd-McLeod procedure for tennis elbow: mid- to long-term results

Abstract

Background: Tennis elbow is a common condition that usually responds to conservative measures. In refractory cases, surgical intervention is indicated. A plethora of surgical techniques have been described. We report the mid- to long-term outcomes of the Boyd-McLeod procedure for refractory tennis elbow.

Methods: A retrospective analysis and current review of patients that had undergone the Boyd-McLeod procedure over a 12-year period was undertaken. Demographics, time to discharge, length of follow-up and outcome scores were collected.

Results: Seventy patients underwent surgery. Mean time to discharge was 15.35 weeks, with 88% successful outcomes. Fifty-four patients were available for current follow-up at mean of 5.52 years (range 1.17 years to 11.49 years). Range of motion in all patients was unchanged. There were no revision procedures. Mean (SD) Mayo Elbow Performance Score was 90.85 (13.11), with 75.5% returning a good or excellent score and 24.5% a fair outcome. The mean (SD) Oxford Elbow Score was 44.04 (6.92); mean (SD) pain score was 89.5 (17.58); mean (SD) function score was 95.34 (9.59) and mean (SD) socio-psychological score was 91.50 (17.01). Overall, 83% of patients had an Oxford Elbow Score of 43 or greater, suggesting excellent outcome.

Conclusions: We show that the Boyd-McLeod procedure is an excellent option over both the short- and long-term for refractory tennis elbow.

Keywords: Boyd–McLeod; lateral epicondylitis; open release; tennis elbow.

Figure 1.

Incision centred over the lateral epicondyle, the superior half of the extensor attachment incised inline with its fibres and lifted sharply from the lateral epicondyle.

Figure 2.

Showing the lateral collateral ligament left undisturbed.

Figure 3.

Showing the conjoint flap after being raised distally, exposure and resection of the proximal 2 mm of the annular ligament, taking with it the synovial lining of the radiohumeral joint. Inspection of the elbow joint can be made and any mucinous degenerate tissue debrided from the extensor carpi radialis brevis.

Figure 4.

Showing the lateral epicondyle being debrided and decorticated using an osteotome.