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Review
. 2019 Feb;11(1):35-44.
doi: 10.1177/1758573217745041. Epub 2017 Dec 11.

Surgery for tennis elbow: a systematic review

Marcus Bateman  1 , Chris Littlewood  2 , Beth Rawson  3 , Amol A Tambe  1
Affiliations
Review

Surgery for tennis elbow: a systematic review

Marcus Bateman et al. Shoulder Elbow. 2019 Feb.

Abstract

Background: There is no consensus on the most suitable treatment for tennis elbow but, in the USA, surgical intervention is increasing despite a lack of supportive research evidence. The aim of this systematic review was to provide a balanced update based on all relevant published randomized controlled trials conducted to date.

Methods: An electronic search of MEDLINE, EMBASE, CINAHL, BNI, AMED, PsycINFO, HBE, HMIC, PubMed, TRIP, Dynamed Plus and The Cochrane Library was complemented by hand searching. Risk of bias was assessed using the Cochrane Risk of Bias Tool and data were synthesized narratively, based on levels of evidence, as a result of heterogeneity.

Results: Twelve studies of poor methodological quality were included. The available data suggest that surgical interventions for tennis elbow are no more effective than nonsurgical and sham interventions. Surgical technique modifications may enhance effectiveness compared to traditional methods but have not been tested against a placebo.

Conclusions: Current research evidence suggests that surgery for tennis elbow is no more effective than nonsurgical treatment based on evidence with significant methodological limitations. Given the recalcitrant nature of tennis elbow for some patients, further research in the form of a high-quality placebo-controlled surgical trial with an additional conservative arm is required to usefully inform clinical practice.

Keywords: elbow; surgery; systematic review; tennis.

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Figures

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Figure 1.
Search Strategy
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Figure 2.
Example search strategy using Medline
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Figure 3.
Study selection flowchart
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Figure 4.
Risk of bias across domains
Figure 5.
Figure 5.
Risk of bias per study
See this image and copyright information in PMC

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