Which Surgery is Best for Tennis Elbow?

Lateral epicondylitis also known as tennis elbow is usually treated conservatively. But surgery may be needed for those patients who do not get better with nonoperative care.

Surgery can be open, percutaneous, or arthroscopic. Open refers to an incision that gives the surgeon access to the area. Percutaneous is the release of soft tissue structures by inserting the surgical tools just under the skin. And arthroscopy is the insertion of a special device that allows the surgeon to see the area being operated on.

Which type of surgery works best? Is one of these three choices able to relieve pain, restore strength, and return the patient to work sooner than the others? Those are the questions surgeons from the Division of Sports Medicine at the University of California (San Francisco) try to answer in this study.

There aren't enough large, single studies to answer these questions directly. Instead, the authors conducted a systematic review of the literature. This means they found and reviewed 33 papers on the subject of surgery for tennis elbow.

Only three of those studies compared surgical methods and reported results. Most of the studies described the outcomes after one of the individual procedures. Good results are reported with surgery. No one technique was better than the others.

The authors suggest that there is a trend to return to work faster with the less invasive operations. This includes percutaneous and arthroscopic surgery. Success of all three methods is about 80 per cent.

Each type of surgery has its own advantages and disadvantages. Until more evidence points to one approach as being superior, surgeons must choose what they think is best for each patient. Further study in this area is needed. Studies of postoperative care should also be done as rehab programs vary and may make a difference in outcomes.

References: Marvin Y. Lo, MD, and Marc R. Safran, MD. Surgical Treatment of Lateral Epicondylitis. In Clinical Orthopaedics and Related Research. October 2007. No. 463. Pp. 98-106.