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British Medical Bulletin Advance Access published online on September 26, 2008
British Medical Bulletin, doi:10.1093/bmb/ldn036
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© The Author 2008. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Operative management of tennis elbow: a quantitative review

Salil Karkhanis{dagger}, Andrew Frost{ddagger} and Nicola Maffulli*,¶

{dagger} Department of Trauma and Orthopaedics, Tameside General Hospital, Ashton under Lyne
{ddagger} Department of Trauma and Orthopaedics, Staffordshire General Hospital, Stafford
Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire ST4 7QB, UK

* Correspondence to: N. Maffulli, Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent ST4 7QB Staffs, UK. E-mail: osa14{at}keele.ac.uk

Introduction: The results of operative management of tennis elbow are varied, and the indications for surgery are not well codified. Many operative techniques are reported, but a clear consensus on whether a given surgical procedure is more effective over another is yet to be reached.

Methods: We conducted a MEDLINE, CINAHL and EMBASE search on all available scientific articles that reported the outcomes of surgery for lateral epicondylopathy. Keywords used were ‘tennis elbow’, ‘lateral epicondylitis’, ‘lateral epicondylalgia’, ‘tendinopathy’, ‘tendonitis’ and ‘tendon’. Subheadings used were ‘surgery’, ‘outcomes’, ‘pathology’, ‘physiology’ and ‘operation’. All relevant articles were retrieved. Each article was scored using the Coleman methodology score (CMS), a highly repeatable methodology score, by two independent reviewers, followed by data analysis.

Results: The mean CMS for the 45 studies identified was 43 ± 9 (of a possible 100 points), with ‘number of patients’, ‘type of study’, ‘outcome criteria and assessment’ and ‘subject selection process’ being the major low scorers. Also, there was no improvement in the CMS, and hence study design, over the years (intra-class correlation coefficient = 0.45).

Discussion: There is a dearth of quality evidence available to be able to advocate one operative technique over another.

Conclusion: We stress the need for well-designed adequately powered randomized controlled trials to be able to understand which of these operative techniques is really superior to the others.

Keywords: tennis elbow • lateral epicondylitis • Coleman • operation

Accepted for publication September 2, 2008.


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