Arthroscopic Suture Anchor Repair and Debridement for Refractory Lateral Epicondylitis Show Significant Clinical Improvement.

Abstract

To retrospectively compare the clinical outcomes of arthroscopic suture anchor repair of the common extensor tendon (CET) and arthroscopic debridement of CET for the treatment of refractory lateral epicondylitis. Patients with refractory lateral epicondylitis who underwent arthroscopic surgery between August 2018 and September 2022 with a minimum 1-year follow-up were included. All patients were divided into 2 groups based on whether they underwent suture anchor repair. The modified Nirschl technique was used to debride the CET lesions in all patients, and modified anchor repair was used for CET insertion reconstruction in patients after January 2021. In short, suture anchor fixation (single-row) was used in patients with tear areas less than 50% of the CET insertion, and suture bridge fixation (double-row) was used in patients with tear areas greater than 50%. The outcomes, including the visual analog scale (VAS) score for pain, the Mayo Elbow Performance Score (MEPS), the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and surgical satisfaction, were measured 1 day preoperatively and at the latest follow-up. The proportion of patients achieving the minimal clinically important difference (MCID) was compared between the groups. A total of 62 patients (60% female) were included in the final analysis (30 in the debridement group and 32 in the repair group). The mean age of the cohort was 47.6 ± 7.3 years, with 77% affecting the dominant arm. The follow-up time was 29.3 ± 3.2 (range, 19-35) months for the debridement group and 27.2 ± 5.4 (range, 20-37) months for the repair group (P = .073). Preoperative patient-reported outcomes were comparable between the groups and significantly improved after surgery. Postoperatively, patients in the repair group had a better MEPS score (95.8 ± 6.9 vs 91.2 ± 8.0; P = .017) and QuickDASH scores (2.2 ± 3.9 vs 4.2 ± 3.9; P = .043), while there were no differences between the 2 groups in terms of VAS scores for pain during rest (0.1 ± 0.4 vs 0.1 ± 0.3; P = .933) or during activity (0.3 ± 0.8 vs 0.4 ± 0.6; P = .639). MCID achievement of VAS score during rest was similar between the repair group (97%) and the debridement group (93%, P = .607), while MCID achievement in the VAS score during activity, MEPS score, and QuickDASH score was 100% in both groups. All patients resumed their daily life and work after surgery, for a surgical satisfaction rate of 98.4%. Arthroscopic suture anchor repair and debridement of the CET insertion resulted in significant clinical improvement in patients with refractory lateral epicondylitis. Level III, retrospective comparative case series.