Extensor carpi radialis brevis tendon repair is necessary for arthroscopic treatment of refractory lateral epicondylitis of the elbow: a prospective randomized comparative study

PURPOSE: The aim of this study was to compare clinical outcomes of arthroscopic debridement and extensor carpi radialis brevis (ECRB) tendon repair with suture anchor reattachment versus arthroscopic debridement alone in patients with refractory lateral epicondylitis (LE). METHODS: From January 2016 to December 2022, 56 eligible patients with recalcitrant LE underwent either arthroscopic debridement alone (Group A, n = 26) or arthroscopic ECRB repair (Group B, n = 30). Clinical outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, visual analog scale (VAS) for pain, grip strength measurement, and 36-Item Short-Form Health Survey (SF-36). RESULTS: There was no difference in preoperative demographics between two groups (P > 0.05). The mean follow-up duration was 29.9 ± 4.8 months (range, 25–38 months) in Group A and 30.4 ± 5.2 months (range, 24–39 months) in Group B. At the final follow-up, both groups showed significant improvements in MEPS, DASH, VAS, and grip strength (P < 0.05). No significant differences were observed in postoperative VAS scores or elbow range of motion between two groups (P > 0.05). However, Group B demonstrated superior MEPS (95.1 ± 8.6 vs. 83.6 ± 8.4, P < 0.001), DASH (9.4 ± 2.3 vs. 17.5 ± 3.2, P < 0.001), grip strength (44.54 ± 10.53 kg vs. 34.12 ± 9.69 kg, P < 0.001), and SF-36 scores (PCS: 52.8 ± 5.7 vs. 45.6 ± 5.1; MCS: 54.7 ± 6.1 vs. 46.1 ± 5.8; P < 0.05) compared to Group A at the final follow-up. No serious complications requiring reoperation were encountered in both groups during the follow-up period. CONCLUSIONS: Arthroscopic ECRB tendon repair with suture anchor reattachment provided significantly better functional recovery, grip strength preservation, and quality-of-life outcomes compared to debridement alone in refractory LE. While both techniques could alleviate pain effectively, tendon repair may be prioritized for patients requiring optimal functional restoration. LEVEL OF EVIDENCE: Prospective randomized comparative study, Level Ⅱ.