AAOS2017: No differences after 1 year between surgery versus sham for chronic tennis elbow

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
This ACE Report is a summary of a conference presentation or abstract. The information provided has limited the ability to provide an accurate assessment of the risk of bias or the overall quality. Please interpret the results with caution as trials may be in progress and select results may have been presented.
26 patients with chronic lateral epicondylitis were randomized to either surgical intervention with the Nirschl technique, or to a sham procedure involving only incision and exposure of the extensor carpi radialis brevis. Patients were followed up postoperatively for 1 year. Results demonstrated no Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Various surgical procedures are available for patients with lateral epicondylitis. One of the most common is the Nirschl technique involving excision of the degenerated area of the extensor carpi radialis brevis tendon. While postoperative outcomes are typically good, many speculate that the outcomes may be no different than sham surgery and that improvement is akin to a placebo effect.
What was the principal research question?
In patients with lateral epicondylitis, how do the results of surgical management with extensor carpi radialis brevis resection compared to sham surgery, assessed over 12-month follow-up?
Population: 26 patients with lateral epicondylitis for at least 6 months and nonresponsive to at least two previous nonoperative treatment modalities.
Intervention: Surgery group: Patients underwent excision of the affected portion of the extensor carpi radialis brevis tendon (Nirschl technique). (n=13)
Comparison: Sham group: Patients only received incision and exposure of the extensor carpi radialis brevis tendon. (n=13)
Outcomes: The primary outcome was a subjective patient assessment of elbow pain frequency postoperatively. Secondary outcomes included elbow pain severity, function, stiffness, epicondyle tenderness, the range of motion in pronation-supination, and grip strength.
Methods: RCT
Time: Reported follow-up time points included 2 weeks, 6 weeks, 3 months, 6 months, and 12 months.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Jason Harvey
March 31, 2017
Orthopaedic Surgeon - Australia
Exposure of the ECRB is not really sham surgery as the CEO complex is manipulated and traumatised which may be the reason people improved. A true sham would be incising the skin only and not touching the extensor mechanism and that would be much more powerful in suggesting surgery was of no value in treating the condition.