Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2023 Jul;51(9):2506-2515. doi: 10.1177/03635465221095565. Epub 2022 Jun 6.
Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.
PURPOSE/HYPOTHESIS: The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.
Systematic review; Level of evidence, 4.
Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.
Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%.
This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.
medial epicondylitis（ME）是一种病理状况，在劳动者和运动员中由于反复的手腕弯曲和前臂旋前导致常见屈肌腱退化而出现。尽管非手术治疗已显示出很高的成功率，但对于需要手术治疗的情况，尚未确立标准化的手术技术。
目的/假设：本研究的目的是对 ME 的手术治疗选择进行系统评价，并评估相关的患者报告结果（PROs）。我们假设 ME 的手术治疗会因研究而异，但没有一种技术会被证明更优越。
系统评价；证据水平，4。
1980 年至 2020 年 4 月期间，使用 PubMed、EMBASE、Cumulative Index of Nursing Allied Health Literature（CINAHL）、SPORTDiscus 和 Cochrane 数据库进行了检索。确定了所有重点关注 ME 手术治疗和 PROs 的 1 至 4 级研究。纳入标准为需要描述手术技术和 PROs。研究人员独立地对研究进行了双重摘要和审查，以确定其是否符合入选标准。计算了人口统计学特征和可用 PROs 的加权平均值。
根据搜索标准，共确定了 851 项研究。共有 16 项研究符合纳入和排除标准，因此进行了评估。发现了三种手术技术：开放性（13 项研究）、关节镜（2 项研究）和经皮（1 项研究）。开放性技术的描述分为有（7 项研究）和无（6 项研究）常见屈肌腱修复。分析包括 479 个肘部；患者主要为男性（58.3%），加权平均年龄为 47.2 岁。加权平均随访时间为 4.6 年。网球和体力劳动者是最常见的运动和职业，分别为 63%和 100%。手术成功率为 63%至 100%，并发症发生率低至 4.3%。重返运动和工作的成功率分别为 81%至 100%和 66.7%至 100%，只有 1 项研究报告的重返工作率<90%。
本系统评价表明，对于难治性 ME，手术干预通常具有很高的成功率。无论进行何种手术技术，患者的 PROs 通常都会得到改善，并且有相当数量的患者返回工作岗位，并发症有限。需要进一步的研究来确定开放性、关节镜和经皮技术之间的优势。
