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



1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran


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


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