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Salvage Surgery for Lateral Tennis Elbow

Nirschl Orthopaedic Sportsmedicine Clinic, Arlington, Virginia

Robert P. Nirschl, MD

Nirschl Orthopaedic Sportsmedicine Clinic, Arlington, Virginia

Barry S. Kraushaar, MD

Nirschl Orthopaedic Sportsmedicine Clinic, Arlington, Virginia

Eric J. Guidi, MD

Nirschl Orthopaedic Sportsmedicine Clinic, Arlington, Virginia

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were per formed between 1979 and 1994. Each patient's non operative and operative history was recorded before our salvage revision surgery. At revision surgery, find ings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the patho logic tissue usually present in the extensor carpi radi alis brevis tendon should be resected. Release oper ations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.

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