Efficacy of arthroscopy in the treatment of lateral epicondylitis: a systematic review with meta-analysis

Аннотация

Lateral epicondylitis, popularly known as tennis elbow, has a high incidence in athletes, around 50%, with a high prevalence in beginners learning the one-handed backhand. It is a clinical orthopaedic condition with a major impact on public health due to its high frequency in manual workers, 10.5% of whom may have lateral elbow pain and 2.4% of whom have a confirmed diagnosis. The aim of this study is to compare the effectiveness of arthroscopic versus non-arthroscopic techniques (open and percutaneous). This is a systematic review with meta- analysis. There is no need for approval by the ethics committee or institutional scientific review board. The reference lists of the included and previously published articles were searched for more relevant studies that met the eligibility criteria. Based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Five articles were selected containing patients diagnosed with lateral epicondylitis who underwent surgical treatment by arthroscopy, open surgery and/or percutaneous surgery. A total of 544 patients were included, with a mean age of 46 years. Of The American Journal of Medical Sciences and Pharmaceutical Research 45 https://www.theamericanjournals.com/index.php/tajmspr these, 347 were treated by arthroscopy, 81 by open tendon than on the other epicondyle tendons. Since surgery and 42 by percutaneous surgery. The results anatomically, the other extensors are muscular and this were analyzed using the DASH (Disabilities of the arm, one is tendinous⁵. shoulder and hand) score, which assesses dysfunctions Another scientific hypothesis is that epicondylitis is a of the arm, shoulder and hand. In addition, some studies clinical manifestation of elbow instability, anatomically analyzed the VAS (Visual Analogue Scale) index, patient justified by the proximity between the extensor carpi satisfaction, complications and other clinical assessment radialis brevis and the collateral ligaments. This may scales.Arthroscopic, open and percutaneous surgeries justify the ligament laxity found in patients undergoing proved to be effective methods for treating lateral diagnostic arthroscopy for this pathology⁵. epicondylitis.However, because arthroscopy is a method Historically, this pathology was thought to be a self- that allows a complete intra-articular evaluation and limiting disease, however, persistent pain is detected in adequate release of the tendons without ligament most patients, even when treated for a year with involvement, it was associated with a better prognosis in conservative methods8 and subsequent local injections terms of pain, limb mobility and consequent patient of corticosteroids have also shown unfavorable results, satisfaction when compared to open and percutaneous especially in those with a pain duration of more than 6 procedures. months8 . Numerous forms of conservative treatment have been Keywords: Lateral epicondylitis; Arthroscopy; established, with immobilization, avoidance of manual Treatment. work, physiotherapy, systemic or local anti- inflammatories and radiofrequency to relieve pain.12,13,14 However, patients who don't respond Introduction: Lateral epicondylitis, popularly known as positively or those with a period of 6 months of tennis elbow, has a high incidence in athletes, around complaints become candidates for surgical 50%, with a high prevalence in beginners learning the intervention.9 one-handed backhand. It is a clinical orthopaedic condition with a major impact on public health due to Numerous techniques have been proposed to free the its high frequency in manual workers, 10.5% of whom origin of the common extensor.12 Firstly, it was can present with lateral elbow pain and 2.4% of whom performed by the open route, first described by Nirschl have a confirmed diagnosis. ¹,² and Pettrone in 1979. 13Later, in 1982, Baumgard and Schwartz 14 were the first to describe percutaneous This condition affects 1 to 3% of the general release, with the patient under local anesthesia, for the population, mainly between the ages of 35 and 50. treatment of lateral epicondylitis.13,14 1,2,3 In most cases it can be successfully treated conservatively, with relief within one year. 3 However, With the popularity of elbow arthroscopy, the use of 4% to 11% of patients persist with complaints, leading arthroscopic methods has been explored for the to a surgical approach which results in “good” or treatment of this pathology in refractory cases.15 It was “excellent” results in 80% to 90% of cases.4,5 first described in 2000 by Blaker et al 16 in a small series of cases with 42 releases. Since then, numerous articles The mechanism of trauma is often ergonomics, hence have established that this is a viable option for cases the high prevalence and higher incidence in heavy that are refractory and chronic to non-operative manual workers and workers who perform repetitive treatment.17,18 Therefore, the aim of this study is to m