Clinical Review

Open vs Percutaneous vs Arthroscopic Surgical Treatment of Lateral Epicondylitis: An Updated Systematic Review

Publish date: June 11, 2018

References

Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015;43(5):1066-1071. doi:10.1177/0363546514568087.
Lo MY, Safran MR. Surgical treatment of lateral epicondylitis: a systematic review. Clin Orthop Relat Res. 2007;463:98-106. doi:10.1097/BLO.0b013e3181483dc4.
Balk ML, Hagberg WC, Buterbaugh GA, Imbriglia JE. Outcome of surgery for lateral epicondylitis (tennis elbow): effect of worker’s compensation. Am J Orthop. 2005;34(3):122-126; discussion 126.
Barth J, Mahieu P, Hollevoet N. Extensor tendon and fascia sectioning of extensors at the musculotendinous unit in lateral epicondylitis. Acta Orthop Belg. 2013;79(3):266-270.
Bigorre N, Raimbeau G, Fouque PA, Cast YS, Rabarin F, Cesari B. Lateral epicondylitis treatment by extensor carpi radialis fasciotomy and radial nerve decompression: is outcome influenced by the occupational disease compensation aspect? Orthop Traumatol Surg Res. 2011;97(2):159-163. doi:10.1016/j.otsr.2010.11.007.
Cho BK, Kim YM, Kim DS, et al. Mini-open muscle resection procedure under local anesthesia for lateral and medial epicondylitis. Clin Orthop Surg. 2009;1(3):123-127. doi:10.4055/cios.2009.1.3.123.
Coleman B, Quinlan JF, Matheson JA. Surgical treatment for lateral epicondylitis: a long-term follow-up of results. J Shoulder Elbow Surg. 2010;19(3):363-367. doi:10.1016/j.jse.2009.09.008.
Dunn JH, Kim JJ, Davis L, Nirschl RP. Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med. 2008;36(2):261-266. doi:10.1177/0363546507308932.
Manon-Matos Y, Oron A, Wolff TW. Combined common extensor and supinator aponeurotomy for the treatment of lateral epicondylitis. Tech Hand Up Extrem Surg. 2013;17(3):179-181. doi:10.1097/BTH.0b013e31829e0eeb.
Meknas K, Odden-Miland A, Mercer JB, Castillejo M, Johansen O. Radiofrequency microtenotomy: a promising method for treatment of recalcitrant lateral epicondylitis. Am J Sports Med. 2008;36(10):1960-1965. doi:10.1177/0363546508318045.
Pruzansky ME, Gantsoudes GD, Watters N. Late surgical results of reattachment to bone in repair of chronic lateral epicondylitis. Am J Orthop. 2009;38(6):295-299.
Rayan F, Rao V Sr, Purushothamdas S, Mukundan C, Shafqat SO. Common extensor origin release in recalcitrant lateral epicondylitis – role justified? J Orthop Surg Res. 2010;5:31. doi:10.1186/1749-799X-5-31.
Reddy VR, Satheesan KS, Bayliss N. Outcome of Boyd-McLeod procedure for recalcitrant lateral epicondylitis of elbow. Rheumatol Int. 2011;31(8):1081-1084. doi:10.1007/s00296-010-1450-1.
Rubenthaler F, Wiese M, Senge A, Keller L, Wittenberg RH. Long-term follow-up of open and endoscopic Hohmann procedures for lateral epicondylitis. Arthroscopy. 2005;21(6):684-690. doi:10.1016/j.arthro.2005.03.017.
Ruch DS, Orr SB, Richard MJ, Leversedge FJ, Mithani SK, Laino DK. A comparison of debridement with and without anconeus muscle flap for treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg. 2015;24(2):236-241. doi:10.1016/j.jse.2014.09.035.
Siddiqui MA, Koh J, Kua J, Cheung T, Chang P. Functional outcome assessment after open tennis elbow release: what are the predictor parameters? Singapore Med J. 2011;52(2):73-76.
Solheim E, Hegna J, Øyen J. Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):1023-1027. doi:10.1007/s00167-011-1477-1.
Svernlöv B, Adolfsson L. Outcome of release of the lateral extensor muscle origin for epicondylitis. Scand J Plast Reconstr Surg Hand Surg. 2006;40(3):161-165. doi:10.1080/02844310500491492.
Tasto JP, Cummings J, Medlock V, Hardesty R, Amiel D. Microtenotomy using a radiofrequency probe to treat lateral epicondylitis. Arthroscopy. 2005;21(7):851-860. doi:10.1016/j.arthro.2005.03.019.
Thornton SJ, Rogers JR, Prickett WD, Dunn WR, Allen AA, Hannafin JA. Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med. 2005;33(10):1558-1564. doi:10.1177/0363546505276758.
Wang AW, Erak S. Fractional lengthening of forearm extensors for resistant lateral epicondylitis. ANZ J Surg. 2007;77(11):981-984. doi:10.1111/j.1445-2197.2007.04294.x.
Baker CL Jr, Baker CL 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. 2008;36(2):254-260. doi:10.1177/0363546507311599.
Grewal R, MacDermid JC, Shah P, King GJ. Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. J Hand Surg Am. 2009;34(5):849-857. doi:10.1016/j.jhsa.2009.02.006.
Jerosch J, Schunck J. Arthroscopic treatment of lateral epicondylitis: indication, technique and early results. Knee Surg Sports Traumatol Arthrosc. 2006;14(4):379-382. doi:10.1007/s00167-005-0662-5.
Kim JW, Chun CH, Shim DM, et al. Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1178-1183. doi:10.1007/s00167-011-1507-z.
Lattermann C, Romeo AA, Anbari A, et al. Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg. 2010;19(5):651-656. doi:10.1016/j.jse.2010.02.008.
Mullett H, Sprague M, Brown G, Hausman M. Arthroscopic treatment of lateral epicondylitis: clinical and cadaveric studies. Clin Orthop Relat Res. 2005;439:123-128. doi:10.1097/01.blo.0000176143.08886.fe.
Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. 2014;23(10):1527-1531. doi:10.1016/j.jse.2014.05.010.
Othman AM. Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow. Arch Orthop Trauma Surg. 2011;131(3):383-388. doi:10.1007/s00402-011-1260-2.
Rhyou IH, Kim KW. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res. 2013;471(1):284-290. doi:10.1007/s11999-012-2585-z.
Wada T, Moriya T, Iba K, et al. Functional outcomes after arthroscopic treatment of lateral epicondylitis. J Orthop Sci. 2009;14(2):167-174. doi:10.1007/s00776-008-1304-9.
Yoon JP, Chung SW, Yi JH, et al. Prognostic factors of arthroscopic extensor carpi radialis brevis release for lateral epicondylitis. Arthroscopy. 2015;31(7):1232-1237. doi:10.1016/j.arthro.2015.02.006.
Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015;24(1):67-73. doi:10.1016/j.jse.2014.07.017.
Kaleli T, Ozturk C, Temiz A, Tirelioglu O. Surgical treatment of tennis elbow: percutaneous release of the common extensor origin. Acta Orthop Belg. 2004;70(2):131-133.
Lin MT, Chou LW, Chen HS, Kao MJ. Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies. Evid Based Complement Alternat Med. 2012;2012:142941. doi:10.1155/2012/142941.
Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM. Clinical and ultrasonographic results of ultrasonographically guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis. Am J Sports Med. 2011;39(11):2429-2435. doi:10.1177/0363546511417096.
Zhu J, Hu B, Xing C, Li J. Ultrasound-guided, minimally invasive, percutaneous needle puncture treatment for tennis elbow. Adv Ther. 2008;25(10):1031-1036. doi:10.1007/s12325-008-0099-6.
Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-related outcomes instruments. J Hand Surg Am. 2013;38(4):641-649. doi:10.1016/j.jhsa.2012.12.032.
Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18(3):205-207. doi:10.1136/emj.18.3.205.
Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927-932. doi:10.1016/j.jse.2009.03.021.
Cummins CA. Lateral epicondylitis: in vivo assessment of arthroscopic debridement and correlation with patient outcomes. Am J Sports Med. 2006;34(9):1486-1491. doi:10.1177/0363546506288016.
Stapleton TR, Baker CL. Arthroscopic treatment of lateral epicondylitis: a clinical study. Arthroscopy. 1996;1:365-366.
Hastings H. Open treatment for lateral tennis elbow good for certain indications. Orthop Today. 2009;2:1-2.
Duparc F, Putz R, Michot C, Muller JM, Fréger P. The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow. Surg Radiol Anat. 2002;24(5):302-307. doi:10.1007/s00276-002-0055-0.

STATISTICAL ANALYSIS

Data from all studies were pooled and descriptive statistics were reported as weighted mean ± weighted standard deviation for continuous variables and frequency with percentage for categorical variables. A meta-analysis was performed for all outcome measures that were reported in 3 or more studies within a specific treatment cohort. Data were analyzed using 2-sample and 2-proportion Z-tests. Results were considered statistically significant at P < .05.

RESULTS

LITERATURE RESEARCH

Using the aforementioned search strategy, 154 studies were identified. Following application of the inclusion and exclusion criteria, 35 studies were included in the analysis (Figure 1). One study compared open and percutaneous techniques, and another compared arthroscopic and percutaneous techniques, rendering a total of 19 studies examining open surgical techniques for treatment of lateral epicondylitis,^3-21 12 studies examining arthroscopic techniques,^14,22-32 and 6 studies reporting percutaneous surgical treatment of lateral epicondylitis^29,33-37 (Table 2). There was1 level I study (3%), 6 level III studies (17%), and 28 level IV studies (80%).

Table 2. Study Demographic Data for Open, Arthroscopic, and Percutaneous Lateral Epicondylectomy

	Open	Arthroscopic	Percutaneous	Total
Number of studies	19	12	6	35
Level of evidence
I	1 (5%)	0	0	1 (3%)
II	0	0	0	0
III	3 (16%)	4 (33%)	1 (17%)	6 (17%)
IV	15 (79%)	8 (67%)	5 (83%)	28 (80%)
US: International	8:12	3:9	1:5	12:24
Journals of publication
AJSM	3	1	1	5
JSES	2	2	1	5
Arthroscopy	2	2	0	3
KSSTA	1	2	0	3
CORR	0	2	0	2
JHS	0	1	0	1
JOS	1	1	0	2
AJO	2	0	0	2
Other	8	1	4	12

Abbreviations: AJO, The American Journal of Orthopedics; AJSM, American Journal of Sports Medicine; Arthroscopy, The Journal of Arthroscopy and Related Surgery; CORR, Clinical Orthopaedics & Related Research; JHS, Journal of Hand Surgery; JOS, Journal of Orthopaedic Surgery; JSES, Journal of Shoulder and Elbow Surgery; KSSTA, Knee Surgery, Sports Traumatology, and Arthroscopy.

SUBJECT DEMOGRAPHICS

The 35 included studies comprised 1579 patients and 1640 elbows. Among these, 1055 (64%) elbows underwent open (O), 401 (25%) underwent arthroscopic (A), and 184 (11%) underwent percutaneous (P) treatment. The average age was 45.7 years, 47% of the patients were male, 43% were laborers, 31% had worker’s compensation claims, and the dominant extremity was involved in 62% of patients. The percutaneous cohort was older than the open cohort (P = 46.9, O = 45.4, A = 45.8; P = .036). The duration of symptoms was shorter in the percutaneous cohort than in the other 2 groups and shorter in the arthroscopic cohort than in the open cohort (P = 8 months, O = 23 months, A = 18 months; P < .001). There were no significant differences between groups regarding gender, occupation, worker’s compensation status, or involvement of the dominant extremity (Table 3).

Table 3. Subject Demographics for Open, Arthroscopic, and Percutaneous Groups

	Open	Arthroscopic	Percutaneous
Subjects (N)	999	397	183
Elbows (N)	1055	401	184
Elbows with follow-up (%)	915 (87%)	350 (87%)	181 (98%)
Males (%)	427 (47%)	173 (49%)	78 (43%)
Females (%)	488 (53%)	177 (51%)	103 (57%)
Mean age (years)	45.4	45.8	46.9
Dominant elbow (%)	70%	69%	53%
Laborer (%)	56%	53%	48%
Work comp (%)	36%	30%	NR
Symptoms to operation (months)	23	18	8
Min. symptoms to operation (months)	6	6	3
Mean follow-up (months)	60	44	11

MATA-ANALYSIS CLINICAL OUTCOMES

Clinical outcome results were pooled for all studies reporting the same outcome measure for the same technique (open, arthroscopic, or percutaneous). A meta-analysis was performed for all outcome measures that were reported in a minimum of 3 studies utilizing the same surgical technique (Table 4).

PAIN RELIEF

Thirteen open studies,^{3,5,7,8,11-16,18,19,21} 7 arthroscopic studies^{14,22-24,26,27,31} and 0 percutaneous studies reported the proportion of patients who were pain free at final follow-up. The proportion of patients who were pain free following open débridement was greater than that in the arthroscopic cohort (O = 70%, A = 60%; P = .009) (Table 4).

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References

Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015;43(5):1066-1071. doi:10.1177/0363546514568087.
Lo MY, Safran MR. Surgical treatment of lateral epicondylitis: a systematic review. Clin Orthop Relat Res. 2007;463:98-106. doi:10.1097/BLO.0b013e3181483dc4.
Balk ML, Hagberg WC, Buterbaugh GA, Imbriglia JE. Outcome of surgery for lateral epicondylitis (tennis elbow): effect of worker’s compensation. Am J Orthop. 2005;34(3):122-126; discussion 126.
Barth J, Mahieu P, Hollevoet N. Extensor tendon and fascia sectioning of extensors at the musculotendinous unit in lateral epicondylitis. Acta Orthop Belg. 2013;79(3):266-270.
Bigorre N, Raimbeau G, Fouque PA, Cast YS, Rabarin F, Cesari B. Lateral epicondylitis treatment by extensor carpi radialis fasciotomy and radial nerve decompression: is outcome influenced by the occupational disease compensation aspect? Orthop Traumatol Surg Res. 2011;97(2):159-163. doi:10.1016/j.otsr.2010.11.007.
Cho BK, Kim YM, Kim DS, et al. Mini-open muscle resection procedure under local anesthesia for lateral and medial epicondylitis. Clin Orthop Surg. 2009;1(3):123-127. doi:10.4055/cios.2009.1.3.123.
Coleman B, Quinlan JF, Matheson JA. Surgical treatment for lateral epicondylitis: a long-term follow-up of results. J Shoulder Elbow Surg. 2010;19(3):363-367. doi:10.1016/j.jse.2009.09.008.
Dunn JH, Kim JJ, Davis L, Nirschl RP. Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med. 2008;36(2):261-266. doi:10.1177/0363546507308932.
Manon-Matos Y, Oron A, Wolff TW. Combined common extensor and supinator aponeurotomy for the treatment of lateral epicondylitis. Tech Hand Up Extrem Surg. 2013;17(3):179-181. doi:10.1097/BTH.0b013e31829e0eeb.
Meknas K, Odden-Miland A, Mercer JB, Castillejo M, Johansen O. Radiofrequency microtenotomy: a promising method for treatment of recalcitrant lateral epicondylitis. Am J Sports Med. 2008;36(10):1960-1965. doi:10.1177/0363546508318045.
Pruzansky ME, Gantsoudes GD, Watters N. Late surgical results of reattachment to bone in repair of chronic lateral epicondylitis. Am J Orthop. 2009;38(6):295-299.
Rayan F, Rao V Sr, Purushothamdas S, Mukundan C, Shafqat SO. Common extensor origin release in recalcitrant lateral epicondylitis – role justified? J Orthop Surg Res. 2010;5:31. doi:10.1186/1749-799X-5-31.
Reddy VR, Satheesan KS, Bayliss N. Outcome of Boyd-McLeod procedure for recalcitrant lateral epicondylitis of elbow. Rheumatol Int. 2011;31(8):1081-1084. doi:10.1007/s00296-010-1450-1.
Rubenthaler F, Wiese M, Senge A, Keller L, Wittenberg RH. Long-term follow-up of open and endoscopic Hohmann procedures for lateral epicondylitis. Arthroscopy. 2005;21(6):684-690. doi:10.1016/j.arthro.2005.03.017.
Ruch DS, Orr SB, Richard MJ, Leversedge FJ, Mithani SK, Laino DK. A comparison of debridement with and without anconeus muscle flap for treatment of refractory lateral epicondylitis. J Shoulder Elbow Surg. 2015;24(2):236-241. doi:10.1016/j.jse.2014.09.035.
Siddiqui MA, Koh J, Kua J, Cheung T, Chang P. Functional outcome assessment after open tennis elbow release: what are the predictor parameters? Singapore Med J. 2011;52(2):73-76.
Solheim E, Hegna J, Øyen J. Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):1023-1027. doi:10.1007/s00167-011-1477-1.
Svernlöv B, Adolfsson L. Outcome of release of the lateral extensor muscle origin for epicondylitis. Scand J Plast Reconstr Surg Hand Surg. 2006;40(3):161-165. doi:10.1080/02844310500491492.
Tasto JP, Cummings J, Medlock V, Hardesty R, Amiel D. Microtenotomy using a radiofrequency probe to treat lateral epicondylitis. Arthroscopy. 2005;21(7):851-860. doi:10.1016/j.arthro.2005.03.019.
Thornton SJ, Rogers JR, Prickett WD, Dunn WR, Allen AA, Hannafin JA. Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med. 2005;33(10):1558-1564. doi:10.1177/0363546505276758.
Wang AW, Erak S. Fractional lengthening of forearm extensors for resistant lateral epicondylitis. ANZ J Surg. 2007;77(11):981-984. doi:10.1111/j.1445-2197.2007.04294.x.
Baker CL Jr, Baker CL 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. 2008;36(2):254-260. doi:10.1177/0363546507311599.
Grewal R, MacDermid JC, Shah P, King GJ. Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. J Hand Surg Am. 2009;34(5):849-857. doi:10.1016/j.jhsa.2009.02.006.
Jerosch J, Schunck J. Arthroscopic treatment of lateral epicondylitis: indication, technique and early results. Knee Surg Sports Traumatol Arthrosc. 2006;14(4):379-382. doi:10.1007/s00167-005-0662-5.
Kim JW, Chun CH, Shim DM, et al. Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1178-1183. doi:10.1007/s00167-011-1507-z.
Lattermann C, Romeo AA, Anbari A, et al. Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg. 2010;19(5):651-656. doi:10.1016/j.jse.2010.02.008.
Mullett H, Sprague M, Brown G, Hausman M. Arthroscopic treatment of lateral epicondylitis: clinical and cadaveric studies. Clin Orthop Relat Res. 2005;439:123-128. doi:10.1097/01.blo.0000176143.08886.fe.
Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. 2014;23(10):1527-1531. doi:10.1016/j.jse.2014.05.010.
Othman AM. Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow. Arch Orthop Trauma Surg. 2011;131(3):383-388. doi:10.1007/s00402-011-1260-2.
Rhyou IH, Kim KW. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res. 2013;471(1):284-290. doi:10.1007/s11999-012-2585-z.
Wada T, Moriya T, Iba K, et al. Functional outcomes after arthroscopic treatment of lateral epicondylitis. J Orthop Sci. 2009;14(2):167-174. doi:10.1007/s00776-008-1304-9.
Yoon JP, Chung SW, Yi JH, et al. Prognostic factors of arthroscopic extensor carpi radialis brevis release for lateral epicondylitis. Arthroscopy. 2015;31(7):1232-1237. doi:10.1016/j.arthro.2015.02.006.
Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015;24(1):67-73. doi:10.1016/j.jse.2014.07.017.
Kaleli T, Ozturk C, Temiz A, Tirelioglu O. Surgical treatment of tennis elbow: percutaneous release of the common extensor origin. Acta Orthop Belg. 2004;70(2):131-133.
Lin MT, Chou LW, Chen HS, Kao MJ. Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies. Evid Based Complement Alternat Med. 2012;2012:142941. doi:10.1155/2012/142941.
Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM. Clinical and ultrasonographic results of ultrasonographically guided percutaneous radiofrequency lesioning in the treatment of recalcitrant lateral epicondylitis. Am J Sports Med. 2011;39(11):2429-2435. doi:10.1177/0363546511417096.
Zhu J, Hu B, Xing C, Li J. Ultrasound-guided, minimally invasive, percutaneous needle puncture treatment for tennis elbow. Adv Ther. 2008;25(10):1031-1036. doi:10.1007/s12325-008-0099-6.
Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-related outcomes instruments. J Hand Surg Am. 2013;38(4):641-649. doi:10.1016/j.jhsa.2012.12.032.
Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18(3):205-207. doi:10.1136/emj.18.3.205.
Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927-932. doi:10.1016/j.jse.2009.03.021.
Cummins CA. Lateral epicondylitis: in vivo assessment of arthroscopic debridement and correlation with patient outcomes. Am J Sports Med. 2006;34(9):1486-1491. doi:10.1177/0363546506288016.
Stapleton TR, Baker CL. Arthroscopic treatment of lateral epicondylitis: a clinical study. Arthroscopy. 1996;1:365-366.
Hastings H. Open treatment for lateral tennis elbow good for certain indications. Orthop Today. 2009;2:1-2.
Duparc F, Putz R, Michot C, Muller JM, Fréger P. The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow. Surg Radiol Anat. 2002;24(5):302-307. doi:10.1007/s00276-002-0055-0.

Open vs Percutaneous vs Arthroscopic Surgical Treatment of Lateral Epicondylitis: An Updated Systematic Review

References

STATISTICAL ANALYSIS

RESULTS

LITERATURE RESEARCH

SUBJECT DEMOGRAPHICS

MATA-ANALYSIS CLINICAL OUTCOMES

PAIN RELIEF

Pages

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