Arthroscopic and Open Surgery Show Comparable Efficacy in the Treatment of Lateral Epicondylitis: A Systematic Review.

PURPOSE

The purpose of this systematic review is to compare the outcomes of open surgery versus arthroscopic surgery in the treatment of lateral epicondylitis, focusing on pain relief, functional recovery, complication rates, and patient satisfaction, in order to provide evidence-based recommendations for clinical practice and identify areas for future research.

METHODS

The systematic review process was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search was conducted across PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science. Studies comparing open and arthroscopic surgery for lateral epicondylitis were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized studies. Outcomes assessed included recurrence pain, persistent pain, infection rates, reoperation rates, nerve-related complications, hematoma, patient satisfaction, visual analog scale, disabilities of the arm, shoulder, and hand score, operation time, and return to work time. Both randomized controlled trials (RCTs) and non-RCTs were included.

RESULTS

14 studies, comprising 6 RCTs and 8 cohort studies with a total of 20153 participants, were included. Both surgical techniques yielded comparable outcomes in terms of recurrence pain (arthroscopic: 0% to 13.3%; open: 2.9% to 13.2%), persistent pain (arthroscopic: 0% to 13.3%; open: 0% to 11.9%), patient dissatisfaction (arthroscopic: 4.9% to 13.3%; open: 3.8% to 16.7%), infection rates (arthroscopic: 0% to 13.3%; open: 0% to 6.7%), reoperation rates (arthroscopic: 2.4% to 7.1%; open: 2.9% to 5.3%), nerve-related complications (arthroscopic: 0% to 6.7%; open: 0% to 7.7%), and hematoma (arthroscopic: 0% to 5%; open: 0% to 6.7%). The surgical time for arthroscopy (34 to 36 min) was generally longer than that for the open group (22.5 to 34.7 min). No significant differences in functional outcomes were observed in the majority of studies.

CONCLUSIONS

Both arthroscopic and open surgeries provide similar clinical outcomes for lateral epicondylitis, with no significant differences in functional results. Despite longer operative times, arthroscopic surgery is expected to become the preferred approach due to its minimally invasive nature.