A comparative meta-analysis of the efficacy and safety of arthroscopic versus open surgery in patients with lateral epicondylitis

Background

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.

Methods

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.

Results

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).

Conclusions

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.