title: A comparison of débridement with and without anconeus muscle flap for treatment of refractory lateral epicondylitis.
abstract: BACKGROUND
  Lateral epicondylitis is a common condition encountered by orthopedic surgeons. Whereas the majority of patients improve with conservative management, a small percentage will require surgery. The purpose of this study was to compare the clinical outcomes of surgical débridement of the common extensor origin alone with débridement combined with rotation of an anconeus muscle flap in patients who failed to respond to conservative management of chronic lateral epicondylitis.
  
  
  METHODS
  Fifty-seven patients who failed to respond to a minimum of 5 months of conservative treatment for lateral epicondylitis were retrospectively reviewed. Patients in group 1 were treated with open débridement of the common extensor origin. Patients in group 2 were treated with open débridement combined with rotation of an anconeus muscle flap. Outcome measures included elbow range of motion, grip strength, visual analog scale (VAS) for pain score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Statistical analyses were performed by Student's t test with 95% confidence intervals.
  
  
  RESULTS
  At final follow-up, average DASH scores were significantly lower in group 2. There were no significant differences between the groups with regard to elbow range of motion or grip strength. VAS pain scores were significantly reduced in both groups. Preoperative VAS pain scores were significantly greater in group 2; however, at final follow-up, there was no significant difference between groups. There were no apparent complications in either group.
  
  
  CONCLUSIONS
  In addition to débridement of the common extensor origin, the rotation of an anconeus muscle flap may improve outcomes in cases of lateral epicondylitis that require operative intervention.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Ruch
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. Electronic address: OrrS@HSS.EDU.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Orr
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Richard
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Fraser J
authors.initials: FJ
authors.lastname: Leversedge
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Mithani
authors.affiliation: The Seattle Hand Surgery Group, Seattle, WA, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Laino
mesh_terms: D000328:Adult; D003646:Debridement; D004185:Disability Evaluation; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D059352:Musculoskeletal Pain / Q000209:etiology; D010147:Pain Measurement; D016059:Range of Motion, Articular; D019233:Retreatment; D012189:Retrospective Studies; D013524:Surgical Flaps; D013716:Tennis Elbow / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy
keywords: Lateral epicondylitis; anconeus; common extensor; muscle flap; rotation flap; tennis elbow