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Ten- to 14-Year Follow-up of the Nirschl Surgical Technique for Lateral Epicondylitis

Jonathan H. Dunn, MD^,*, John J. Kim, MD, Lonnie Davis, MD and Robert P. Nirschl, MD, MS^||

From Barrington Orthopedic Specialists, Buffalo Grove, Illinois, Prince William Orthopaedics, Hand Surgery and Sportsmedicine, Manassas, Virginia, Center for Orthopaedics and Sports Medicine, Falls Church, Virginia, and ^|| Nirschl Orthopaedic Center for Sports Medicine and Joint Reconstruction, Arlington, Virginia

^* Address correspondence to Jonathan H. Dunn, MD, Barrington Orthopedic Specialists, 404 North McHenry Road, Buffalo Grove, IL 60089 (e-mail: dun1000{at}yahoo.com).

Background: Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques.

Hypothesis: Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up.

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

Methods: Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1 surgeon between 1991 and 1994 were retrospectively reviewed. Eighty-three patients (92 elbows) were available by telephone for a mean follow-up of 12.6 years (range, 10–14 years). Outcome measures included the Numeric Pain Intensity Scale, Nirschl and Verhaar tennis elbow–specific scoring systems, and American Shoulder and Elbow Surgeons elbow form. Preoperative data were collected retrospectively.

Results: The mean age of the study group was 46 years (range, 23–70 years) with 45 men and 38 women. Eighty-seven of the procedures were primary, and 5 were revision tennis elbow surgeries. Concomitant procedures were performed in 30 patients including ulnar nerve release in 24 patients, medial tennis elbow procedures in 23 patients, shoulder arthroscopy in 2 patients, carpal tunnel release in 1 patient, and triceps debridement and osteophyte excision in 1 patient. The mean duration of preoperative symptoms was 2.2 years (range, 2 months to 10 years). The mean Nirschl tennis elbow score improved from 23.0 to 71.0, and the mean American Shoulder and Elbow Surgeons score improved from 34.3 to 87.7 at a minimum of 10-year follow-up (P < .05). The Numeric Pain Intensity Scale pain score improved from 8.4 preoperatively to 2.1 (P < .05). Results were rated as excellent in 71 elbows, good in 6 elbows, fair in 9 elbows, and poor in 6 elbows by the Nirschl tennis elbow score. By the criteria of Verhaar et al, the results were excellent in 45 elbows, good in 32 elbows, fair in 8 elbows, and poor in 7 elbows. Eighty-four percent good to excellent results were achieved using both scoring systems. Ninety-two percent of the patients reported normal elbow range of motion. The overall improvement rate was 97%. Patient satisfaction averaged 8.9 of 10. Ninety-three percent of those available at a minimum of 10-year follow-up reported returning to their sports.

Conclusion: The mini-open Nirschl surgical technique with accurate resection of the tendinosis tissue remains highly successful in the long term.

Key Words: tennis elbow • lateral epicondylitis • long-term follow-up • surgery • tendinosis