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Treatment of Recalcitrant Lateral Epicondylitis With Suture Anchor Repair

From the Sports Medicine and Shoulder Service, Hospital for Special Surgery, Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, New York

^* Address correspondence to Jo A. Hannafin, MD, PhD, 535 East 70th Street, New York, NY 10021 (e-mail: HannafinJ{at}hss.edu).

Background: Chronic lateral epicondylitis has been treated with various surgical procedures with varying and often less-than-satisfactory outcomes.

Hypothesis: The use of suture anchor repair of the extensor carpi radialis brevis to the lateral epicondyle in the treatment of chronic lateral epicondylitis will result in a more anatomical repair, with resultant improvements in strength, pain, and return to previous sport.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 20 patients (22 elbows) were treated surgically and were observed for a minimum of 2 years. All patients had debridement of the degenerative tissue, followed by repair of the extensor carpi radialis brevis to the lateral epicondyle with a suture anchor. The average time to follow-up was 4.2 years (range, 2.2–9.5 years). All patients completed a Disabilities of the Arm, Shoulder, and Hand questionnaire to assess residual disability, and 16 patients underwent a physical examination. The objective evaluation included the assessment of range of motion, grip strength, and pinch strength. Pain was assessed preoperatively and postoperatively using a visual analog pain scale. Patients were also questioned with regard to a return to their previous level of activities.

Results: The grip and pinch strengths achieved for the operative extremity were 110% and 106%, respectively, of the nonoperative limb. The 16 patients who underwent a physical examination had achieved full range of motion, with 15 (94%) returning to their previous level of activity at an average time of 4.1 months. The mean preoperative pain score was 8.1 (range, 4.0–10.0), whereas the mean postoperative pain score was 0.41 (range, 0–1.5), indicating significant pain relief (P < .001). The Disabilities of the Arm, Shoulder, and Hand scores demonstrated only mild residual disability (mean, 6.6) at follow-up.

Conclusion: The use of a suture anchor to repair the extensor carpi radialis brevis to the epicondyle after debridement was a satisfactory procedure for recalcitrant lateral epicondylitis with regard to strength, return to previous activities, and pain relief.

Key Words: lateral epicondylitis • suture anchor • recalcitrant • Disabilities of the Arm, Shoulder, and Hand (DASH)

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