Background:

Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.

Purpose/Hypothesis:

The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.

Results:

Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%.

Conclusion:

This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.

中文翻译：

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内上髁炎的手术技术和临床结果：系统评价

背景：

内上髁炎（ME）是一种病理性疾病，发生于劳动者和运动员中，继发于重复的手腕弯曲和前臂旋前，导致屈肌腱退化。尽管非手术治疗的成功率很高，但对于需要手术治疗的情况，尚未建立标准化的手术技术。

目的/假设：

本研究的目的是对 ME 的手术治疗方案进行系统评价，并评估相关的患者报告结果 (PRO)。我们假设 ME 的手术治疗因研究而异，但没有任何技术被证明是更优越的。

学习规划：

系统审查；证据级别，4。

方法：

使用 PubMed、EMBASE、护理联合健康文献累积索引 (CINAHL)、SPORTDiscus 和 Cochrane 数据库在 1980 年至 2020 年 4 月期间进行检索。确定了所有 1 至 4 级研究，重点关注 ME 背景下的手术管理和 PRO 。纳入时需要描述手术技术和 PRO。研究人员独立地对研究的资格进行双重摘要和审查。计算人口特征和可用 PRO 的加权平均值。

结果：

总体而言，根据检索标准确定了 851 项研究。共有 16 项研究符合纳入和排除标准，因此进行了评估。发现了三种手术技术：开放手术（13 项研究）、关节镜手术（2 项研究）和经皮手术（1 项研究）。开放技术的描述被细分为有（7项研究）和没有（6项研究）共同屈肌腱修复的技术。分析包括 479 个弯头；患者主要为男性（58.3%），加权平均年龄为 47.2 岁。加权平均随访时间为 4.6 年。网球和体力劳动分别是最常见的运动和职业。手术成功率为 63% 至 100%，并发症发生率低至 4.3%。重返运动和工作的成功率分别为81%-100%和66.7%-100%，只有1项研究报告重返工作率<90%。

结论：

这项系统评价表明，难治性 ME 的手术干预通常具有很高的成功率。无论采用何种手术技术，患者的 PRO 值普遍有所改善，令人鼓舞的是，许多患者返回工作岗位时并发症有限。需要进一步研究以确定开放、关节镜和经皮技术之间的优越性。