Tennis Elbow Surgery
Most cases of tennis elbow and golfer’s elbow will respond to non-operative measures, including “Counter Force Bracing”, a structured therapy program and time. In fact, with a structured rehabilitation program, the majority of tennis elbow and golfer’s elbow cases will respond favourably.
At SOS, we sometimes will recommend arthroscopic surgery for recalcitrant tennis elbow (Common Extensor Origin Tendinopathy and Tearing). This surgery is known as arthroscopic debridment and release for Tennis Elbow. We occasionally suggest arthroscopic Golfer’s Elbow Surgery or Common Flexor Origin debridement and release.
Unfortunately, it is difficult to predict how long it will take for symptoms of “Tennis Elbow” or Lateral Epicondylitis to resolve. In some cases, it may take years to settle. The same is true for Golfer’s Elbow.
Suppose you are suffering from Tennis Elbow or Golfer’s Elbow and have not responded to the usual non-operative measures. In that case, surgery may be appropriate, particularly if a “Tear of the Common Extensor Origin or Common Flexor Origin” is diagnosed on an Ultrasound Scan.
MRI is very helpful in the diagnostic work-up, especially in questionable cases of Tennis Elbow and Golfer’s Elbow, or to confirm the presence of a CEO (Common Extensor Origin) Tear or CFO (Common Flexor Origin) Tear. Ultrasound scans lack the sensitivity and specificity to differentiate CEO or CFO tears from tendinosis in some cases.
The 3T MRI scan below of the elbow clearly shows tearing of the CEO in both coronal and axial sequences.
A diagnostic elbow arthroscopy is performed to exclude other causes of lateral or medial elbow pain. We then confirm the torn ECRB tendon (CEP tear) or torn CFO and localise the exact site of the pathology, which can often be seen quite clearly at arthroscopy (see photo below). We now use a combined ultrasound-guided and Arthroscopically assisted approach.
We then either debride the tear arthroscopically or perform a “mini-open” release and repair through a small 2 cm incision. This surgery is almost always performed as a “Day Case”.
The success rate of this type of surgery is in the order of 90% or more, particularly if the “Nirschl Lesion” or degenerate ECRB tendon tissue can be found and excised. With a “mini-open” approach, the tissues can be easily repaired, suturing healthy tissue to healthy tissue.
Historically, suture anchors were used to repair torn tissue anatomically back to the bone; however, this seems to lead to higher rates of radial nerve irritation.
Following surgery for tennis elbow, patients may immediately start moving their wrist and elbow and begin a gradual strengthening programme. Only a sling for comfort is required post op for 1-2 days. Most patients recover from their surgery within a matter of weeks and typically return to full activity by approximately 2-3 months postoperatively.
Below is an actual case demonstrating the localisation of a tear arthroscopically and a mini-open approach. The CEO Tear and epicondyle are debrided, and microfracture is then performed to encourage “pluripotent cells (similar to stem cells) from the marrow to enter the surgery site. Accelerated rehab postoperatively is usually possible in most cases..