Clinical Outcomes of Radial Collateral Ligament Repair in Recalcitrant Lateral Epicondylitis with Mild Elbow Instability Following Repeated Steroid Injections

Background: Lateral epicondylitis is a common degenerative condition of the elbow, often managed conservatively. However, a subset of patients who had recalcitrant symptoms and repeated corticosteroid injections may develop subtle lateral elbow instability, particularly involving the radial collateral ligament (RCL). This study aimed to evaluate the clinical outcomes of RCL repair combined with open ECRB debridement in patients with chronic lateral epicondylitis and mild instability. Methods: We retrospectively reviewed 92 patients who underwent surgery for recalcitrant lateral epicondylitis between 2016 and 2022. Twelve patients with imaging and intraoperative findings of mild lateral instability underwent open RCL repair with or without LUCL augmentation (unstable group). The remaining 80 patients without instability underwent arthroscopic ECRB release and drilling (stable group). Pre- and postoperative outcomes were assessed using VAS, MEPS, DASH, and range of motion. Comparative analyses were performed between the two groups. Results: All unstable patients had a history of repeated steroid injections (mean 3.4) for 18 months. Postoperatively, pain scores (VAS) improved from 6.8 to 1.4, MEPS increased from 53 to 91, and DASH decreased from 47.1 to 13.8. No major complications or recurrent instability were observed at one-year follow-up. Subgroup analysis revealed that older age, previous surgery, and a greater number of injections were significantly associated with instability. Conclusions: RCL repair combined with ECRB debridement yields favorable clinical outcomes in patients with recalcitrant lateral epicondylitis and mild instability, especially those who had a history of repeated corticosteroid injections. Proper evaluation and surgical repair of underlying ligament pathology may improve outcomes in this subset of patients. Favorable clinical outcomes were defined as improvements compared to preoperative baseline scores. These outcomes were compared to preoperative scores and exceeded MCID thresholds where applicable.