Ghandour Maher, Al Salloum Diaa, Jaber Mohamad Houssein, Abou Orm Ghadi, Ghosn Ali, Jaber Sadek, Abd El Nour Hicham, Chalfoun Anthony, Dagher Tanios, Hanna Bashour
Department of Orthopedic Surgery, CHU Grenoble Alpes, Grenoble, France.
Department of Orthopedic Surgery, APHP Henri Mondor, Paris, France.
J Orthop. 2024 Jul 25;59:41-50. doi: 10.1016/j.jor.2024.07.018. eCollection 2025 Jan.
Lateral epicondylitis frequently necessitates surgical management when non-surgical treatments are ineffective. Anecdotal evidence suggests comparable efficacy between arthroscopic and open surgical repair; however, it is limited by the scarcity of data. This meta-analysis compares between both procedures regarding functional recovery, pain intensity, complications, and return-to-work time.
A detailed systematic review and meta-analysis of research published until February 2024 were performed, comparing arthroscopic and open surgery methods for lateral epicondylitis. The studies were sourced from PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The included studies examined outcomes such as functional recovery, pain intensity, complication rates, and time to return to work. The risk of bias was evaluated using the Cochrane tool for randomized studies and the ROBINS-I tool for non-randomized studies.
The meta-analysis included 19 studies with a total of 20,409 participants. The analysis found no significant differences in postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores (Mean Difference [MD] = 0.06; 95 % Confidence Interval [CI]: 0.81 to 0.94; P = 0.89) or Mayo Elbow Performance Scores (MD = 0.31; 95 % CI: 2.33 to 2.95; P = 0.80) between the arthroscopic and open surgical methods. The rates of good-to-excellent recovery, surgical failures, and complications were similar across both techniques. Nevertheless, arthroscopic surgery was associated with a significantly shorter return-to-work period (MD = -1.64 months; 95 % CI: 2.60 to -0.68; P = 0.001) and a temporary increase in grip strength six months after surgery (MD = -1.50 kg; 95 % CI: 2.67 to -0.33; P = 0.012).
Arthroscopic and open release techniques for lateral epicondylitis provide similar functional outcomes and complication rates. However, arthroscopic surgery may allow for a quicker return to work, suggesting a potential advantage in the early postoperative period. These findings highlight the need for individualized surgical decision-making based on patient-specific factors and surgeon expertise.
当非手术治疗无效时，外侧上髁炎常常需要手术治疗。轶事证据表明关节镜手术和开放手术修复的疗效相当；然而，数据稀缺限制了这方面的研究。本荟萃分析比较了这两种手术在功能恢复、疼痛强度、并发症及恢复工作时间方面的差异。
对截至2024年2月发表的研究进行了详细的系统评价和荟萃分析，比较关节镜手术和开放手术治疗外侧上髁炎的效果。研究来源于PubMed、Scopus、科学网、考克兰图书馆和谷歌学术。纳入的研究考察了功能恢复、疼痛强度、并发症发生率和恢复工作时间等结果。使用考克兰随机研究工具和ROBINS - I非随机研究工具评估偏倚风险。
荟萃分析纳入了19项研究，共20409名参与者。分析发现，关节镜手术和开放手术方法在术后手臂、肩部和手部功能障碍（DASH）评分（平均差[MD]=0.06；95%置信区间[CI]：0.81至0.94；P = 0.89）或梅奥肘关节功能评分（MD = 0.31；95% CI：2.33至2.95；P = 0.80）方面无显著差异。两种技术的良好至优秀恢复率、手术失败率和并发症发生率相似。然而，关节镜手术与显著更短的恢复工作时间相关（MD = -1.64个月；95% CI：-2.60至-0.68；P = 0.001），且术后6个月握力暂时增加（MD = -1.50 kg；95% CI：-2.67至-0.33；P = 0.012）。
外侧上髁炎的关节镜手术和开放手术技术提供了相似的功能结果和并发症发生率。然而，关节镜手术可能使患者更快恢复工作，表明在术后早期具有潜在优势。这些发现强调了基于患者特定因素和外科医生专业知识进行个体化手术决策的必要性。
