Surgical treatment for medial epicondyle tendinopathy: a systematic literature review

Medial epicondyle tendinopathy is a pathology of the common flexor-pronator elbow tendon. Surgical intervention is indicated if conservative management modalities fail. This review aimed to determine if surgical intervention is an effective treatment for medial epicondyle tendinopathy in general population adults. Studies measuring pain, using the Visual Analogue Scale; grip strength, using a hand-held dynamometer; and/or function, using a validated quantitative tool, following surgical management of medial epicondyle tendinopathy in patients aged ≥18 years were searched for. Databases searched included Cochrane Library, MEDLINE, OpenGrey and PubMed. Study quality was assessed using the NICE quality appraisal checklist for quantitative studies reporting correlations and associations, and findings were presented in accordance with PRISMA guidelines. Four case series including a total of 105 (11 treated arthroscopically, 34 percutaneous and 60 open) patients with mean ages of 45-52.5 years met the inclusion criteria. All 4 studies measured validated quantitative outcomes, including MEPI (n=2), DASH (n=2) and VAS (n=2). One study observed significant improvements in VAS (P=0.006) and DASH (P=0.04), while another observed a significant improvement in MEPI (P<.0001). Post-operative complication rates for each approach were 18.18% (2/11) for arthroscopic, 0% (0/60) for open and 0% (0/34) for percutaneous. Study quality ranged from low (n=1) to medium (n=3) for internal validity, and medium (n=1) to high (n=3) for external validity. In conclusion, there is a small-sized (n=4) and weak recommendation for using surgical management of medial epicondyle tendinopathy in general population adults, owning to the limited and generally low-quality of evidence.