The Current Insight of Three Operative Approach for Lateral Epicondylitis: A Systematic Review & Meta-Analysis from 1944 Elbows

OBJECTIVE: Lateral epicondylitis (LE), also commonly known as tennis elbow, is one of the most common causes of lateral epicondyle pain. Most LE cases can resolve spontaneously or with conservative treatment. However, up to 10% of the patients still do not respond to the conservative treatment, making the operative treatment still needed. Yet, the best approach remains controversial, which leaves the option to the individual surgeon’s experience and ease of the procedure. Our study aims to objectively find the difference in the outcome of the operative modalities qualitatively and quantitatively. METHODS: This study was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline where the protocol was registered PROSPERO [ID: CRD42022339650]. OCEBM level I-IV evidence studies were discovered using Boolean search strings that were created according to the patient, intervention, comparison, and outcomes of the study in three databases. Study quality was assessed with the Cochrane RoB tool and MINORS score. The success rate from operative modalities becomes the main outcome of the current study. RESULTS: Forty-six studies were included in the study after a comprehensive literature search was done. From the analysis of 1944 elbows in three different groups, we found that arthroscopic surgery has the highest success rate (91.9%) compared to percutaneous (90.6%) and open (82.7%) lateral epicondylitis surgery with a change in mean pain score of 5.54, 4.90, and 3.63 respectively. The functional outcome improved according to DASH, in the arthroscopic group (51.51 to 15.47), the percutaneous group (44.90 to 10.47), and the open group (53.55 to 16.13). The overall improvement was also found in the MAYO score, in the arthroscopic group (55.12 to 64.70), in the percutaneous group (56.31 to 87.65), and the open group (64 to 93.37). CONCLUSION: Among the three different modalities of lateral epicondylitis surgery, arthroscopic surgery has the highest rate of success with the highest mean difference in pain score. Every surgical outcome also has an overall improvement in functional outcome scores.