Superior Outcomes of Arthroscopic Extensor Carpi Radialis Brevis Repair Over Debridement for Refractory Lateral Epicondylitis

Background To compare the outcomes after arthroscopic repair versus debridement of the extensor carpi radialis brevis (ECRB) in patients with refractory lateral epicondylitis. Methods Patients who underwent arthroscopic debridement or repair of the pathologic ECRB were enrolled. Clinical outcomes were assessed using Disabilities of the Arm, Shoulder and Hand (DASH) scores, visual analog scale (VAS) pain scores, Mayo Elbow Performance Scores (Mayo score), and Return-to-Work Duration at minimum 1-year follow-up. Postoperative Magnetic resonance imaging (MRI) evaluated ECRB tendon healing. Results A total of 41 patients participated in this study. 23 patients accepted ECRB debridement procedure (Debridement group), and the other 18 accepted ECRB repair procedure (Repair group). At the final follow-up, there were no significant differences between the Debridement group and the Repair group regarding the DASH score (36 ± 9 vs 32 ± 3; MD: 4.0, 95%CI: -0.5 to 8.5; p = NS), or Mayo score (88 ± 8 vs 93 ± 8; MD: -5.0, 95%CI: -10.2 to 0.2; p = NS). However, there was a statistically significant difference in VAS score (1.1 ± 0.8 vs 0.6 ± 0.7; MD: 0.5, 95%CI: 0.1 to 0.9; p = 0.02) between the debridement group and the Repair group after surgery. The Repair group had a significantly shorter Return-to-Work Duration than the Debridement group (2 ± 1 vs. 6 ± 3 weeks; MD: -4.0 weeks, 95%CI: -5.3 to -2.7; p < 0.001). MRI revealed complete ECRB healing (Grade 0/1) in 100% of repair patients versus 85% in the debridement group. Conclusion Compared to arthroscopic ECRB debridement, arthroscopic ECRB repair produced better outcomes. Arthroscopic ECRB repair provided a minimally invasive technique with quicker return-to-work than ECRB debridement for refractory lateral epicondylitis. Level of Evidence: Level III, retrospective comparative case series.