Arthroscopic Surgery vs Non-Operative Treatment for Tennis Elbow

Overseen By J W Pollock, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Hospital Research Institute

Disqualifiers: Previous elbow trauma, Cognitive difficulties, others

Compensation: Varies

Number of Visits: Unknown

Duration: Immediate post-operative period

68 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Arthroscopic tennis elbow release for tennis elbow?

Research shows that arthroscopic surgery for tennis elbow, compared to open surgery, allows patients to return to work earlier and requires less postoperative therapy, with similar good or excellent outcomes in most cases. ^{1 2 3 4 5}

Is arthroscopic surgery for tennis elbow safe?

Arthroscopic surgery for tennis elbow generally has a low complication rate of about 1.1%, making it a relatively safe option for treating this condition. ^{1 2 6 7 8}

How does arthroscopic surgery differ from other treatments for tennis elbow?

Arthroscopic surgery for tennis elbow is unique because it allows doctors to see inside the joint and address any additional issues while specifically targeting the affected tendon. This minimally invasive approach typically results in less pain and a quicker return to normal activities compared to traditional open surgery. ^{1 2 4 5 9}

What is the purpose of this trial?

We propose a randomized, double-blind controlled trial comparing arthroscopic release with arthroscopic debridement for the management of chronic tennis elbow in an effort to definitively determine whether arthroscopic tennis elbow release is an effective treatment of tennis elbow, and to further provide better recommendations for the use of this procedure, in an effort to improve patient care.

Research Team

J W Pollock, MD

Principal Investigator

The Ottawa Hospital

Eligibility Criteria

This trial is for individuals who have been experiencing tennis elbow symptoms for at least 9 months and haven't improved with standard treatments. It's not suitable for those with workers' compensation claims, previous severe elbow injuries or surgeries, or other conditions that better explain their symptoms.

Inclusion Criteria

I have had tennis elbow symptoms for over 6 months and treatments haven't worked.

I am over 18 years old and my bones have stopped growing.

Provision of informed consent

Exclusion Criteria

I have tennis elbow on both arms.

I am able to understand and provide consent, and can reliably complete questionnaires.

Alternative diagnosis that better explain their symptoms

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo either arthroscopic tennis elbow release or non-operative management

Immediate post-operative period

Follow-up

Participants are monitored for safety and effectiveness after treatment

24 months

Treatment Details

Interventions

• Arthroscopic tennis elbow release
• Non operative

Trial Overview The study is comparing two surgical methods to treat chronic tennis elbow: arthroscopic release versus arthroscopic debridement. Participants will be randomly assigned to one of the procedures in a double-blind setting to determine which is more effective.

Participant Groups

Group I: Arthroscopic tennis elbow release Active Control 1 Intervention

This group will have arthroscopic tennis elbow release through a standard, two-portal technique,

Group II: Non Operative Placebo Group 1 Intervention

control group will not undergo a second portal or muscle release.

Arthroscopic tennis elbow release is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Arthroscopic tennis elbow release for:

• Chronic lateral epicondylitis
• Tennis elbow

Approved in United States as Arthroscopic tennis elbow release for:

• Chronic lateral epicondylitis
• Tennis elbow

Approved in Canada as Arthroscopic tennis elbow release for:

• Chronic lateral epicondylitis
• Tennis elbow

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

Findings from Research

A systematic review of 34 studies involving 1508 patients with lateral epicondylitis found no significant difference in pain relief and functional outcomes between open and arthroscopic surgery techniques.

However, the arthroscopic procedure was associated with significantly fewer postoperative complications compared to the open surgery method (33.4% vs 57.3%), suggesting it may be a safer option for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Outcomes of Open versus Arthroscopic Surgery for Lateral Epicondylitis, Evidence from a Systematic Review. Moradi, A., Pasdar, P., Mehrad-Majd, H., et al.[2022]

In a study of 61 patients who underwent open surgical release for tennis elbow, 96.7% reported symptom improvement post-surgery, indicating the procedure is highly effective.

Patients with diabetes mellitus experienced worse outcomes, including higher pain scores, reduced grip strength, and increased recurrence rates, highlighting the need for careful preoperative counseling for diabetic patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional outcome assessment after open tennis elbow release: what are the predictor parameters? Siddiqui, MA., Koh, J., Kua, J., et al.[2011]

In a study of 87 patients with resistant lateral epicondylitis, both open and arthroscopic release procedures showed similar outcomes, with 69% of open cases and 72% of arthroscopic cases achieving good or excellent results.

Patients who underwent arthroscopic release returned to work sooner and needed less postoperative therapy compared to those who had open release, suggesting a potential advantage in recovery time with the arthroscopic approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Peart, RE., Strickler, SS., Schweitzer, KM.[2022]

A study involving 24 patients with tennis elbow showed that small incision surgical techniques resulted in significant improvements in pain and function, with the mean visual analog scale (VAS) score decreasing from 7.2 to 3.5 points after surgery.

The procedure demonstrated a low complication rate and high patient satisfaction, making it a recommended option for those who do not respond to non-operative treatments for tennis elbow.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgical Treatment of Tennis Elbow; Minimal Incision Technique. Amroodi, MN., Mahmuudi, A., Salariyeh, M., et al.[2020]

Conservative treatments for lateral epicondylitis (tennis elbow) show a high success rate of 70-90% after one year, but some cases may require surgical intervention.

The described three-portal arthroscopic technique for treating lateral epicondylitis offers better visualization and lower morbidity compared to traditional open surgery, allowing for quicker recovery and return to normal activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Three-Portal Technique in Arthroscopic Lateral Epicondylitis Release. Gowda, A., Kennedy, G., Gallacher, S., et al.[2020]

The overall complication rate for lateral epicondylar release procedures is low at 3.3%, with open procedures having the highest rate at 4.3%, while percutaneous and arthroscopic methods show lower rates of 1.9% and 1.1%, respectively.

In higher-level studies that directly compared the different surgical methods, complication rates were even lower, indicating that both percutaneous and arthroscopic techniques may offer safer options for managing lateral epicondylitis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Complications of Lateral Epicondylar Release. Pomerantz, ML.[2022]

Lateral epicondylitis, commonly known as tennis elbow, affects 1% to 3% of the population, primarily those aged 35 to 50, and is characterized by a failure of the tendon to heal rather than inflammation.

Most cases respond well to nonsurgical treatments like physical therapy and corticosteroid injections, but if these fail, arthroscopic surgery has a high success rate, with improvement reported in 91% to 97.7% of patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Arthroscopic tennis elbow release. Savoie, FH., O'Brien, MJ.[2022]

Lateral epicondylitis, commonly known as tennis elbow, affects 1% to 3% of the population and is primarily caused by overloading the tendon, particularly at the extensor carpi radialis brevis, despite the term 'epicondylitis' suggesting inflammation.

Nonsurgical treatments, such as rest, physiotherapy, and platelet-rich plasma injections, are preferred, while surgery is considered only if pain and functional disability persist, with both open and arthroscopic techniques showing good outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

LATERAL EPICONDYLITIS OF THE ELBOW. Cohen, M., da Rocha Motta Filho, G.[2022]

Arthroscopic surgery for recalcitrant lateral epicondylitis significantly reduced pain levels, with the visual analog scale (VAS) scores dropping from an average of 7.05 before surgery to 3.20 after surgery over a follow-up period of 42 months.

The Quick DASH score, which measures elbow function, improved from 63.18 to 25.68 post-surgery, indicating a substantial enhancement in patients' daily activities and overall arm function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Midterm Results of Arthroscopic Treatment for Recalcitrant Lateral Epicondylitis of the Elbow. Saremi, H., Seydan, MA., Seifrabiei, MA.[2022]

References

1. Iran pubmed.ncbi.nlm.nih.gov

Clinical Outcomes of Open versus Arthroscopic Surgery for Lateral Epicondylitis, Evidence from a Systematic Review. [2022]

2. India pubmed.ncbi.nlm.nih.gov

Functional outcome assessment after open tennis elbow release: what are the predictor parameters? [2011]

3. United States pubmed.ncbi.nlm.nih.gov

Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. [2022]

4. Iran pubmed.ncbi.nlm.nih.gov

Surgical Treatment of Tennis Elbow; Minimal Incision Technique. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

The Three-Portal Technique in Arthroscopic Lateral Epicondylitis Release. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Complications of Lateral Epicondylar Release. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Arthroscopic tennis elbow release. [2022]

8. Brazil pubmed.ncbi.nlm.nih.gov

LATERAL EPICONDYLITIS OF THE ELBOW. [2022]

9. Iran pubmed.ncbi.nlm.nih.gov

Midterm Results of Arthroscopic Treatment for Recalcitrant Lateral Epicondylitis of the Elbow. [2022]