Asian Journal of Orthopaedic Research

Background: Lateral epicondylitis (LE) refractory to non-operative care is commonly treated using either open or arthroscopic debridement/repair. However, the comparative effectiveness and safety of these approaches remain debated. This systematic review and meta-analysis aimed to compare clinical outcomes, complication rates and reoperation rates between arthroscopic and open surgery for LE.

Methods: A systematic review and meta-analysis of comparative studies was conducted in accordance with PRISMA principles. PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library were searched for eligible studies comparing arthroscopic and open surgical treatment for refractory LE. Reference lists of relevant studies and previous reviews were also screened manually to identify additional eligible studies. Adult patients with LE undergoing arthroscopic versus open debridement and/or repair were eligible. The primary outcomes were patient-reported function, measured using QuickDASH or DASH, and pain, measured using the visual analogue scale (VAS). Secondary outcomes included grip strength, flexion-extension range of motion (ROM), complications and reoperation. Mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Fixed-effect or random-effects models were applied according to statistical heterogeneity. Risk of bias was assessed using RoB 2.0 for randomised trials and MINORS for non-randomised comparative studies.

Results: Six comparative studies were included. Pooled analyses demonstrated no significant differences between arthroscopic and open approaches in QuickDASH score (MD -1.47; 95% CI -5.65 to 2.71; p = 0.49), DASH score (MD -1.22; 95% CI -6.30 to 3.86; p = 0.64), VAS pain score (MD -0.18; 95% CI -0.64 to 0.28; p = 0.44), grip strength (MD 0.73 kg; 95% CI -1.36 to 2.83; p = 0.49) or flexion-extension ROM (MD -0.36°; 95% CI -2.19 to 1.47; p = 0.70). Reoperation rates (RR 0.93; 95% CI 0.71 to 1.22; p = 0.61) and complication rates (RR 1.06; 95% CI 0.65 to 1.74; p = 0.82) were also comparable. The observed between-group differences were small and below commonly accepted thresholds for clinically important differences.

Conclusion: Arthroscopic and open surgery for refractory lateral epicondylitis provide comparable improvements in pain, function, grip strength, ROM and safety, with no significant difference in reoperation rates. Procedure selection should therefore be individualised according to patient characteristics, suspected intra-articular pathology, surgeon expertise and resource availability. Future multicentre randomised trials with standardised operative, rehabilitation and outcome-reporting protocols are warranted.