Yao Lei, Xiong Yan, Ma Wenjing, Li Jian, Tang Xin
Sports Medicine Center, West China Hospital, Sichuan University, and Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Sports Medicine Center, West China Hospital, Sichuan University, and Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Arthroscopy. 2025 Aug;41(8):2821-2830.e1. doi: 10.1016/j.arthro.2024.11.070. Epub 2024 Nov 23.
To retrospectively compare the clinical outcomes of arthroscopic suture anchor repair of the common extensor tendon (CET) and arthroscopic debridement of CET for the treatment of refractory lateral epicondylitis.
Patients with refractory lateral epicondylitis who underwent arthroscopic surgery between August 2018 and September 2022 with a minimum 1-year follow-up were included. All patients were divided into 2 groups based on whether they underwent suture anchor repair. The modified Nirschl technique was used to debride the CET lesions in all patients, and modified anchor repair was used for CET insertion reconstruction in patients after January 2021. In short, suture anchor fixation (single-row) was used in patients with tear areas less than 50% of the CET insertion, and suture bridge fixation (double-row) was used in patients with tear areas greater than 50%. The outcomes, including the visual analog scale (VAS) score for pain, the Mayo Elbow Performance Score (MEPS), the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and surgical satisfaction, were measured 1 day preoperatively and at the latest follow-up. The proportion of patients achieving the minimal clinically important difference (MCID) was compared between the groups.
A total of 62 patients (60% female) were included in the final analysis (30 in the debridement group and 32 in the repair group). The mean age of the cohort was 47.6 ± 7.3 years, with 77% affecting the dominant arm. The follow-up time was 29.3 ± 3.2 (range, 19-35) months for the debridement group and 27.2 ± 5.4 (range, 20-37) months for the repair group (P = .073). Preoperative patient-reported outcomes were comparable between the groups and significantly improved after surgery. Postoperatively, patients in the repair group had a better MEPS score (95.8 ± 6.9 vs 91.2 ± 8.0; P = .017) and QuickDASH scores (2.2 ± 3.9 vs 4.2 ± 3.9; P = .043), while there were no differences between the 2 groups in terms of VAS scores for pain during rest (0.1 ± 0.4 vs 0.1 ± 0.3; P = .933) or during activity (0.3 ± 0.8 vs 0.4 ± 0.6; P = .639). MCID achievement of VAS score during rest was similar between the repair group (97%) and the debridement group (93%, P = .607), while MCID achievement in the VAS score during activity, MEPS score, and QuickDASH score was 100% in both groups. All patients resumed their daily life and work after surgery, for a surgical satisfaction rate of 98.4%.
Arthroscopic suture anchor repair and debridement of the CET insertion resulted in significant clinical improvement in patients with refractory lateral epicondylitis.
Level III, retrospective comparative case series.
回顾性比较关节镜下缝合锚钉修复伸肌总腱（CET）与关节镜下清理CET治疗难治性外侧上髁炎的临床疗效。
纳入2018年8月至2022年9月间接受关节镜手术且至少随访1年的难治性外侧上髁炎患者。所有患者根据是否接受缝合锚钉修复分为两组。所有患者均采用改良的Nirschl技术清理CET损伤，2021年1月后对患者采用改良锚钉修复进行CET止点重建。简而言之，对于撕裂面积小于CET止点50%的患者采用缝合锚钉固定（单排），对于撕裂面积大于50%的患者采用缝合桥固定（双排）。在术前1天和最新随访时测量各项结果，包括疼痛视觉模拟量表（VAS）评分、梅奥肘关节功能评分（MEPS）、上肢、肩部和手部快速功能障碍评分（QuickDASH）以及手术满意度。比较两组间达到最小临床重要差异（MCID）的患者比例。
最终分析共纳入62例患者（60%为女性）（清创组30例，修复组32例）。该队列的平均年龄为47.6±7.3岁，77%累及优势侧手臂。清创组的随访时间为29.3±3.2（范围19 - 35）个月，修复组为27.2±5.4（范围20 - 37）个月（P = 0.073）。术前两组患者报告的结果具有可比性，术后均有显著改善。术后，修复组患者的MEPS评分（95.8±6.9对91.2±8.0；P = 0.017）和QuickDASH评分（2.2±3.9对4.2±3.9；P = 0.043）更好，而两组在静息时疼痛的VAS评分（0.1±0.4对0.1±0.3；P = 0.933）或活动时疼痛的VAS评分（0.3±0.8对0.4±0.6；P = 0.639）方面无差异。修复组（97%）和清创组（93%，P = 0.607）静息时VAS评分达到MCID的情况相似，而两组在活动时VAS评分、MEPS评分和QuickDASH评分方面达到MCID的比例均为100%。所有患者术后均恢复日常生活和工作，手术满意率为98.4%。
关节镜下缝合锚钉修复和清理CET止点对难治性外侧上髁炎患者有显著的临床改善。
III级，回顾性比较病例系列。
