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

Abstract

Background: Lateral epicondylitis (LE) also known as tennis elbow is a common disease of middle-aged population.<br />Surgery is a treatment of choice in patients not responded to the conservative management. Open and arthroscopic<br />release are the two main choices for LE surgery; however, an overall consensus is not available. This study was aimed<br />to compare the clinical outcomes after conventional open and arthroscopic procedures.<br />Methods: An electronic search of databases including, Medline, Web of Science, Embase, Cochrane Library, and<br />Scopus was conducted to identify all eligible studies describing the post-operative clinical outcomes of patients with<br />LE, up to October 2018. All studies considering the non-pediatric cases who received at least 6-month preoperative<br />conservative treatment and were followed more than 6 months after surgery were included. Data on patient satisfaction,<br />functional outcomes, pain, and complication rates, were extracted for each study. If appropriate, the meta-analysis<br />was performed to combine the results for all outcomes that were reported in a minimum of 3 studies utilizing the same<br />surgical technique.<br />Results: A total of 34 eligible articles including 15 open studies, 13 arthroscopic studies, and 6 studies in both<br />techniques were enrolled. Studies were from different parts of the world with a whole sample size of 1508 cases.<br />Various outcome measuring methods including Quick DASH and VAS, and different clinical outcomes were reported.<br />The results indicated no significant difference between arthroscopic and open surgery methods in terms of VAS,<br />DASH score, time for returning to work, overall outcomes, and patients' satisfaction (P >0.05). However, postoperative<br />complications were significantly higher in the open group when compared with the arthroscopic procedure (57.3%<br />vs 33.4% P=0.001).<br />Conclusion: The present study suggests that despite no superiority for each techniques regarding the pain relief,<br />subjective function, and better rehabilitation, arthroscopic method have been associated with less complications.<br />Level of evidence: II