Surgical Treatment of Lateral Epicondylitis John F. Meyers, M.D.

A Modification of the Bosworth Procedure

Pathology Microtears of the ECRB

Pathology Angiofibroblastic Hyperplasia

Surgical Treatment Release of extensor aponeurosis Release of anular ligament Tendon lengthening Release of extensor aponeurosis Release of anular ligament Tendon lengthening

Surgical Technique Percutaneous release Arthroscopic release Percutaneous release Arthroscopic release

51 elbow in 47 patients Jan 88 – April 95

37 cases in 34 patients

Average age 48 Range 33 – 69

Dominant - 27 Non-Dominant – 9

Conservative Treatment 14.4 mos.

Conservative Treatment Avg. 2,7 cortisone injections

Surgical Technique

Grading – Nirschel Excellent – All activity, no pain Good – All activity, mild pain Excellent – All activity, no pain Good – All activity, mild pain

Grading – Nirschel Fair – Pain with heavy actiity Poor – No improvement Fair – Pain with heavy actiity Poor – No improvement

Results Excellent23 Good 10 Fair3 Poor1 Excellent23 Good 10 Fair3 Poor1

Results ROM Normal Grip Strength Normal ROM Normal Grip Strength Normal

Results 100% returned to work

Results 16/17 returned to sport

Complications Hypertrophy of annular ligament Neuroma Olcranon bursitis Hypertrophy of annular ligament Neuroma Olcranon bursitis

Results Meyers & Frix – 89% G%E

Results Nirschel & Pettrone 85% G&E Verhaar 69% G&E Coonrad & Hooper all satisfactory Nirschel & Pettrone 85% G&E Verhaar 69% G&E Coonrad & Hooper all satisfactory

Dissatisfaction Hypertrophy of annular ligament Pain with activity No improvement in symptoms Hypertrophy of annular ligament Pain with activity No improvement in symptoms

Conclusion Simple reproducible procedure Outpatient procedure Predictable results Simple reproducible procedure Outpatient procedure Predictable results