Kenmoku Tomonori, Nakai Daisuke, Nagura Naoshige, Onuma Kenji, Sukegawa Koji, Tazawa Ryo, Otake Yuya, Takahira Naonobu, Takaso Masashi
Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Faculty of Nursing Orthopedics and Sports medicine, Shikoku University, Tokushima, Japan.
JSES Int. 2022 Apr 22;6(4):696-703. doi: 10.1016/j.jseint.2022.03.004. eCollection 2022 Jul.
We hypothesized that the treatment of recalcitrant lateral epicondylitis requires accurate identification of the painful area to promote remodeling of the degenerated extensor insertion and to stabilize the tendon origin during tendon healing. Thus, we performed tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis.
Twenty patients (21 elbows) were treated with bone marrow venting at the painful area of the lateral epicondyle of the elbow and tenodesis using 2 soft anchors lateral to the capitellum (immediately distal to the painful area) and were followed up for ≥2 years. Patients were assessed using the numerical rating scale for pain and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and objective evaluation included active range of motion.
The mean preoperative and postoperative pain scores were 7.5 and 0.5, respectively, indicating significant pain relief ( < .001). The mean preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 44.2 and 1.0, respectively ( < .001). Two elbows had a slightly positive Thomsen test at the final visit. No recurrence of intra-articular symptoms induced by synovial fringe impingement was observed. Patients experienced more pain at the bone-tendon junction of extensors than at the tendon parenchyma.
Tenodesis with bone marrow venting under local anesthesia was effective for subjective patient satisfaction and positive clinical outcomes at ≥2 years of follow-up in patients with recalcitrant lateral epicondylitis. Intra-articular symptoms can be improved by stabilization of the lateral soft tissue without treatment for intra-articular lesions.
我们推测，顽固性外侧上髁炎的治疗需要准确识别疼痛区域，以促进退化的伸肌附着点重塑，并在肌腱愈合过程中稳定肌腱起点。因此，我们对顽固性外侧上髁炎患者在局部麻醉下进行了带骨髓减压的腱固定术。
20例患者（21个肘部）在肘部外侧上髁疼痛区域接受骨髓减压，并使用2个软锚钉在肱骨小头外侧（疼痛区域的紧邻远端）进行腱固定术，随访时间≥2年。使用疼痛数字评定量表和手臂、肩部和手部快速残疾问卷对患者进行评估，客观评估包括主动活动范围。
术前和术后疼痛评分的平均值分别为7.5和0.5，表明疼痛明显缓解（<0.001）。术前和术后手臂、肩部和手部快速残疾问卷评分的平均值分别为44.2和1.0（<0.001）。在末次随访时，2个肘部的汤姆森试验呈轻度阳性。未观察到由滑膜皱襞撞击引起的关节内症状复发。患者在伸肌的骨-肌腱连接处比在肌腱实质处疼痛更明显。
对于顽固性外侧上髁炎患者，在局部麻醉下进行带骨髓减压的腱固定术在≥2年的随访中，对患者主观满意度和积极的临床结果有效。通过稳定外侧软组织，无需治疗关节内病变即可改善关节内症状。
