Comprehensive Conservative Treatment and Surgical Management of Elbow Common Flexor Tendon and Common Extensor Tendon...

Medial (ME) and lateral epicondylitis (LE) are common elbow pathologies characterized by flexor-pronator and extensor carpi radialis brevis tendinous degeneration, respectively. While nonoperative treatment is often successful, some patients do require surgical intervention. Little data exists on the long-term postoperative recovery outcomes of patients in terms of reoperation rate, return of symptoms, and return to activity. Even further, little information exists describing risk factors associated with failing nonoperative interventions. The purpose of the study was threefold: 1) present the senior author's surgical technique used in the treatment for medial and lateral epicondylitis in those cases refractory to nonoperative management, 2) report the long-term outcomes of patients undergoing operative intervention with this surgical technique, and 3) describe the factors associated with failure of nonoperative management that led to surgical intervention.

Data on demographics, sport participation, medical comorbidities, and attempted preoperative treatment, were collected for patients who underwent surgical intervention for ME and LE. Patients were contacted to obtain data on outcomes including persistent symptoms and ability to return to work. Logistic regression analysis was performed to identify risk factors associated with failure of nonoperative management.

Of 548 patients treated for medial and lateral epicondylitis over the study period, 200 (34.6%) failed conservative measures after mean 14 months of nonoperative treatment. Of the 200 surgical patients, 119/200 (59.5%) were males with mean age of 51.6 years (range 30-72 years). Eighty (80%) percent (160/200) of operative cases were for LE. Patient reported outcomes were obtained from 165/200 patients (82% response rate), with mean 9.1 years of follow up (range 1.1-19.3 years). At time of final follow up, average patient reported percentage of resolution of preoperative symptoms was 94.5%, average current daily elbow pain was 0.4 out of 10. Ninety-six (96%) percent reported ability to return to work fully; 4.2% of patients reported persistent difficulties with activities of daily living. After multivariate logistic regression analysis, diagnoses of hyperlipidemia and anxiety/depression as well as history of smoking were the most significant risk factors for failing nonoperative management.

In this single-surgeon case series, a cost-effective, open, efficient transosseous tunnel repair yielded durable, excellent long-term outcomes, including marked symptom relief, minimal residual pain, and high return to activity rates at a mean 9-year follow-up. When examining risks for failing nonoperative management, hyperlipidemia and greater cumulative risk factor burden were predictive of progression to operative intervention.