Lateral ulnar collateral ligament (LUCL) reconstruction for the treatment of recalcitrant lateral epicondylitis of the elbow: a comparison with open débridement of the extensor origin

Magnetic resonance imaging predicts outcomes of conservative treatment in patients with lateral epicondylitis

BACKGROUND

The clinical validity of positive magnetic resonance imaging findings in lateral epicondylitis is controversial. We hypothesized that magnetic resonance imaging could predict the outcome of conservative treatment. This study determined the relationship between magnetic resonance imaging-defined disease severity and treatment outcomes in patients with lateral epicondylitis.

METHODS

This retrospective single-cohort study included 43 conservatively managed and 50 surgically treated patients with lateral epicondylitis. The magnetic resonance imaging scores and clinical outcomes were examined six months post-treatment, and the former was compared between patients with good and poor treatment outcomes. We developed operating characteristic curves of magnetic resonance imaging scores for treatment outcomes, and divided patients into magnetic resonance imaging-mild and severe groups according to the obtained cut-off value of the scores. We compared the outcomes of conservative treatment with that of surgery for each magnetic resonance imaging severity.

RESULTS

Twenty-nine (67.4%) conservatively treated patients had good outcomes, while 14 (32.6%) had poor outcomes. The magnetic resonance imaging score was higher in patients with poor outcomes; the cut-off value was 6. Forty-three (86.0%) surgically treated patients had good outcomes, while 7 (14.0%) had poor outcomes. There was no significant difference in magnetic resonance imaging scores between patients with good and poor surgical outcomes. In the magnetic resonance imaging-mild group (score ≤ 5), the outcome showed no significant difference between the conservative and surgical treatment groups. In the magnetic resonance imaging-severe group (score≥6), the outcome of conservative treatment was significantly worse than that of surgical treatment.

CONCLUSIONS

The magnetic resonance imaging score was associated with conservative treatment outcomes. A treatment strategy that includes surgery should be considered for patients with severe magnetic resonance imaging findings; this is not recommended for those with mild magnetic resonance imaging findings. Magnetic resonance imaging is helpful in determining the best treatment strategies for patients with lateral epicondylitis.

LEVEL OF EVIDENCE

III, Retrospective cohort study.

Individual Evaluation of the Common Extensor Tendon and Lateral Collateral Ligament Improves the Severity Diagnostic Accuracy of Magnetic Resonance Imaging for Lateral Epicondylitis

The effectiveness of magnetic resonance imaging for diagnosing lateral epicondylitis severity is controversial. We aimed to verify whether individual evaluations of the common extensor tendon and lateral collateral ligament would improve the severity diagnostic accuracy of magnetic resonance imaging for lateral epicondylitis. We obtained coronal images of the lateral elbow in three groups: healthy, clinically mild, and clinically severe. We used our scoring system for evaluation using combined and individual methods. We developed the receiver operating characteristic curve for diagnosis using the scores of the healthy and mild groups and that for severity diagnosis using the scores of the mild and severe groups. The scores, in decreasing value, were those of the severe, mild, and healthy groups, with a significant difference in both methods. The curve for diagnosis showed an area under the curve of 0.85 for the combined evaluation and 0.89 for the individual evaluation, without a significant difference between the methods (p = 0.23). The curve for severity diagnosis showed an area under the curve of 0.69 for combined and 0.81 for individual evaluation, with a significant difference between the methods (p = 0.046). Individual evaluation of the common extensor tendon and lateral collateral ligament improved the severity diagnostic accuracy of lateral epicondylitis.

Imaging Evaluation of Medial and Lateral Elbow Pain: Acute and Chronic Tendon Injuries of the Humeral Epicondyles

Medial and lateral elbow pain are often due to degenerative tendinosis and less commonly due to trauma. The involved structures include the flexor-pronator tendon origin in medial-sided pain and the extensor tendon origin in lateral-sided pain. Multimodality imaging is often obtained to verify the clinically suspected diagnosis, evaluate the extent of injury, and guide treatment decisions. Image-guided procedures can provide symptom relief to support physical therapy and also induce tendon healing. Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases. In this article, we review and illustrate pertinent anatomical structures of the distal humerus, emphasizing the structure and contributions of the flexor-pronator and extensor tendon origins in acute and chronic tendon abnormalities. We also discuss approaches to image-guided treatment and surgical management of medial and lateral epicondylitis.