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Review
. 2024 May 2;12(5):23259671241230291.
doi: 10.1177/23259671241230291. eCollection 2024 May.

Comparison of Clinical Outcomes After Different Surgical Approaches for Lateral Epicondylitis: A Systematic Review and Meta-analysis

Erica Kholinne  1   2 , Leonard Christianto Singjie  1   3 , Maria Anastasia  1 , Felly Liu  4 , Ira Juliet Anestessia  2 , Jae-Man Kwak  5 , In-Ho Jeon  6
Affiliations
Review

Comparison of Clinical Outcomes After Different Surgical Approaches for Lateral Epicondylitis: A Systematic Review and Meta-analysis

Erica Kholinne et al. Orthop J Sports Med. .

Abstract

Background: Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain. When nonoperative treatment fails, 1 of the 3 surgical approaches-open, percutaneous, or arthroscopic-is used. However, determining which approach has the superior clinical outcome remains controversial.

Purpose: To review the outcomes of different operative modalities for LE qualitatively and quantitatively.

Study design: Systematic review; Level of evidence, 4.

Methods: This review was performed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published in PubMed, Medline (via EBSCO), and ScienceDirect databases that treated LE with open, percutaneous, or arthroscopic approaches with at least 12 months of follow-up were included. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Methodological Index for Non-Randomized Studies score. The primary outcome was the success rate of each operative treatment approach-open, percutaneous, and arthroscopic.

Results: From an initial search result of 603 studies, 43 studies (n = 1941 elbows) were ultimately included. The arthroscopic approach had the highest success rate (91.9% [95% CI, 89.2%-94.7%]) compared with the percutaneous (91% [95% CI, 87.3%-94.6%]) and open (82.7% [95% CI, 75.6%-89.8%]) approaches for LE surgery with changes in the mean visual analog scale pain score of 5.54, 4.90, and 3.63, respectively. According to the Disabilities of the Arm, Shoulder and Hand score, the functional outcome improved in the arthroscopic group (from 54.11 to 15.47), the percutaneous group (from 44.90 to 10.47), and the open group (from 53.55 to 16.13). The overall improvement was also found in the Mayo Elbow Performance Score, the arthroscopic group (from 55.12 to 90.97), the percutaneous group (from 56.31 to 87.65), and the open group (from 64 to 93.37).

Conclusion: Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches of LE surgery.

Keywords: arthroscopic; lateral epicondylitis; surgical approach; tennis elbow.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of study inclusion in the review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
MINORS Quality Assessment of the 39 nonrandomized studies; 35 studies were noncomparative and 4 studies (indicated with asterisks) were comparative. The vertical red line represents the cutoff point for noncomparative studies to be considered high quality. MINORS, Methodological Index for Non-Randomized Studies.
Figure 3.
Figure 3.
Forest plots of the success rates for the (A) open approach, (B) percutaneous approach, and (C) arthroscopic approach. Ev/Trt, event/treated.
Figure 4.
Figure 4.
Graphs showing results of pre- versus postoperative functional scores according to surgical approach: (A) the DASH score and (B) the MEPS. DASH, Disabilities of the Arm, Shoulder and Hand; MEPS, Mayo Elbow Performance Score.
See this image and copyright information in PMC

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