Extremities

Clinical Outcomes After Suture Anchor Repair of Recalcitrant Medial Epicondylitis

Abstract

This study evaluated clinical and patient-reported outcomes and return to sport after surgical treatment of medial epicondylitis with suture anchor fixation. Consecutive patients were evaluated after undergoing debridement and suture anchor repair of the flexor-pronator mass for the treatment of medial epicondylitis. Demographic variables, a short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Oxford Elbow Score (OES), and 10-point pain and satisfaction scales were collected. Ability and time to return to sport after surgery were evaluated, and the relationship between predictor variables and both elbow function and return to sport was investigated. Median age at the time of surgery was 55 years (range, 29–65 years), with median follow-up of 40 months (range, 12–67 months). Median QuickDASH score and OES at final follow-up were 2.3 (range, 0–38.6) and 45 (range, 22–48), respectively. Most patients returned to premorbid sporting activities at a median of 4.5 months (range, 2.5–12 months), whereas 4 patients (14%) reported significant limitations at final follow-up. Older age at the time of surgery was predictive of better QuickDASH score and OES (P=.05 and P=.02, respectively). Patients who underwent surgery after a shorter duration of symptoms had better outcomes, but the difference did not reach statistical significance (QuickDASH, P=.09; OES, P=.10). Surgical treatment of recalcitrant medial epicondylitis with suture anchor fixation offers good pain relief and patient satisfaction, with little residual disability. Older age at the time of surgery predicts a better outcome.

Medial epicondylitis as a result of overuse of the flexor-pronator musculature can be a significant source of elbow pain and dysfunction.1 These lesions often affect athletes who must generate repetitive rotatory forces across the elbow joint as well as some manual laborers.2 Repetitive forearm pronation and wrist flexion can be associated with chronic tendinotic changes seen at the medial epicondyle.3 Pathologic changes at the musculotendinous origin of the medial epicondyle are far less common than the lateral counterpart and are often amenable to conservative treatment that includes activity modification and a focused rehabilitation program.4

Recurrence of symptoms after non-surgical treatment can occur in 26% of patients, and it is estimated that 5% to 15% of those with relapsing symptoms ultimately require surgical intervention.1,5 Numerous techniques have been described for the operative treatment of recalcitrant medial epicondylitis. These techniques include percutaneous tendon release, open debridement with or without tendon repair, and medial epicondylectomy.6 Little information is available to guide surgeons on return to recreational activity in patients who have surgical intervention with results based on patient-reported functional outcome measures.

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