Surgical Treatment of Lateral Epicondylitis

Surgical Treatment of Lateral Epicondylitis

John F. Meyers, M.D.John F. Meyers, M.D.

A Modification of the Bosworth ProcedureA Modification of the Bosworth Procedure

PathologyPathology

Microtears of the ECRBMicrotears of the ECRB

PathologyPathology

Angiofibroblastic HyperplasiaAngiofibroblastic Hyperplasia

Surgical TreatmentSurgical Treatment

• Release of extensor aponeurosis

• Release of anular ligament

• Tendon lengthening

• Release of extensor aponeurosis

• Release of anular ligament

• Tendon lengthening

Surgical TechniqueSurgical Technique

• Percutaneous release

• Arthroscopic release

• Percutaneous release

• Arthroscopic release

51 elbow in 47 patientsJan 88 – April 95

51 elbow in 47 patientsJan 88 – April 95

37 cases in 34 patients37 cases in 34 patients

Average age 48Range 33 – 69

Average age 48Range 33 – 69

Dominant - 27Non-Dominant – 9

Dominant - 27Non-Dominant – 9

Conservative Treatment14.4 mos.

Conservative Treatment14.4 mos.

Conservative TreatmentAvg. 2,7 cortisone injections

Conservative TreatmentAvg. 2,7 cortisone injections

Surgical TechniqueSurgical Technique

Grading – NirschelGrading – Nirschel

• Excellent – All activity, no pain

• Good – All activity, mild pain

• Excellent – All activity, no pain

• Good – All activity, mild pain

Grading – NirschelGrading – Nirschel

• Fair – Pain with heavy actiity

• Poor – No improvement

• Fair – Pain with heavy actiity

• Poor – No improvement

ResultsResults

• Excellent 23• Good 10• Fair 3• Poor 1

• Excellent 23• Good 10• Fair 3• Poor 1

ResultsResults

• ROM Normal

• Grip Strength Normal

• ROM Normal

• Grip Strength Normal

ResultsResults

100% returned to work100% returned to work

ResultsResults

16/17 returned to sport16/17 returned to sport

ComplicationsComplications

• Hypertrophy of annular ligament

• Neuroma

• Olcranon bursitis

• Hypertrophy of annular ligament

• Neuroma

• Olcranon bursitis

ResultsResults

Meyers & Frix – 89% G%EMeyers & Frix – 89% G%E

ResultsResults

• Nirschel & Pettrone 85% G&E

• Verhaar 69% G&E

• Coonrad & Hooper all satisfactory

• Nirschel & Pettrone 85% G&E

• Verhaar 69% G&E

• Coonrad & Hooper all satisfactory

DissatisfactionDissatisfaction

• Hypertrophy of annular ligament

• Pain with activity

• No improvement in symptoms

• Hypertrophy of annular ligament

• Pain with activity

• No improvement in symptoms

ConclusionConclusion

• Simple reproducible procedure

• Outpatient procedure

• Predictable results

• Simple reproducible procedure

• Outpatient procedure

• Predictable results