Hanson Zachary C, Stults William P, Lourie Gary M
Dept. of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
The Hand & Upper Extremity Center of Georgia, Atlanta, GA, USA.
JSES Rev Rep Tech. 2023 Aug 26;4(1):33-40. doi: 10.1016/j.xrrt.2023.07.006. eCollection 2024 Feb.
Lateral epicondylitis is a common cause of elbow pain in the general population. It is recognized as a degenerative tendinopathy of the common extensor origin believed to be multifactorial, involving elements of repetitive microtrauma associated with certain physiologic and anatomic risk factors.
Initial treatment typically involves a combination of conservative treatment measures, with up to 90% success at 12-18 months. Surgical treatment is reserved for recalcitrant disease; traditionally involving open surgical débridement of the common extensor origin with reported success rates greater than 90%.
Failure of surgical treatment can be multifactorial and present a challenge in determining the optimum management. Residual symptoms may be due to an incorrect initial diagnosis, inadequate surgical débridement, new pathology as a complication of the initial surgery and/or other patient-related and physician- related factors. Even more of a challenge is the possibility that etiology can be due to a combination of listed factors.
In this review, we review the classification scheme for evaluating failed surgical treatment of LE first proposed by Morrey and expand on this classification system based on the senior author's experience. We present the senior author's preferred systematic approach to evaluation and management of these patients, as well as a salvage surgery technique used by the senior author to address the most common etiologies of surgical failure in these patients.
外侧上髁炎是普通人群肘部疼痛的常见原因。它被认为是一种常见伸肌起点的退行性肌腱病，病因多方面，涉及与某些生理和解剖风险因素相关的重复性微创伤因素。
初始治疗通常包括多种保守治疗措施的联合，在12至18个月时成功率高达90%。手术治疗适用于顽固性病例；传统上是对常见伸肌起点进行开放性手术清创，报道的成功率大于90%。
手术治疗失败可能是多因素的，在确定最佳治疗方案时是一个挑战。残留症状可能是由于初始诊断错误、手术清创不充分、初始手术并发症导致的新病变和//或其他与患者及医生相关的因素。更具挑战性的是病因可能是所列因素的组合。
在本综述中，我们回顾了Morrey首次提出的评估外侧上髁炎手术治疗失败的分类方案，并根据资深作者的经验对该分类系统进行扩展。我们展示了资深作者评估和管理这些患者的首选系统方法，以及资深作者用于处理这些患者手术失败最常见病因的挽救手术技术。
