Laird Harrison

July 16, 2007

July 16, 2007 (Calgary) — In some of the first long-term outcome reports on operations for lateral epicondylitis (tennis elbow), pioneers of open surgery and arthroscopy both announced good results.

The studies showed that physicians could choose between the 2 procedures based on their individual backgrounds and training, said Patrick J. DeMeo, MD, the comoderator of a panel in which the studies were presented at the American Orthopaedic Society for Sports Medicine 31st Annual Meeting here.

"Both procedures can produce excellent results in the long run," Dr. DeMeo, medical director of the Pittsburgh Pirates, told Medscape.

The studies should attract widespread interest, he said. "This is a very common problem that most orthopaedic surgeons see almost every day, and there are very few long-term studies of it."

The arthroscopic study was described by Champ L. Baker III, MD, an orthopaedic resident at the University of Pittsburgh, who worked on the study under his father, Champ L. Baker Jr, MD, of the Hughston Clinic in Columbus, Georgia.

The researchers followed 30 patients (average age, 43 years) for a mean of 10.8 years after surgery. At follow-up, the average visual analog scale (VAS) pain score was 0 at rest, 1.0 with activities of daily living, and 1.9 with work or sports.

The average functional score on the Mayo Clinic Elbow Performance Index was 11.66 of a possible 12. Twenty-six patients (87%) said they were satisfied with the procedure.

The open surgery study was described by Robert P. Nirschl, MD, MS, an associate professor of orthopaedics at Georgetown University in Washington, DC, and used slightly different outcome measures.

Independent evaluators assessed the records of 83 patients (average age, 46 years) on whom Dr. Nirschl operated, with a mean follow-up of 12.6 years. The average overall VAS pain score improved from 8.4 before surgery to 2.1 at follow-up (P < .001).

The average American Shoulder and Elbow Surgeons score for Dr. Nirschl's patients improved from 34.3 to 87.7 (P < .001), and patient satisfaction scores averaged 8.9 of 10.

Although the results of the 2 studies were similar, open surgery offers clear advantages, Dr. Nirschl told Medscape. "The arthroscopic approach involves technical difficulties," he said. "And you need a lot of expensive equipment." A surgeon who isn't an expert with an arthroscope may cut too much tendon or leave pathological tissue in place, he added.

Dr. DeMeo agreed that arthroscopy demands more specialized skill, but he said that it also offers the advantage of a quicker recovery time.

Dr. DeMeo reported no relevant financial relationships. Dr. Nirschl is a consultant to Medical Sports, which manufactures counterforce braces used in lateral epicondylitis treatment.

American Orthopaedic Society for Sports Medicine 31st Annual Meeting. Presented July 14, 2007.


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