title: Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis: an analysis of 3863 patients.
abstract: BACKGROUND
  This study was conducted to identify the rate of failure of operative treatment of lateral epicondylitis, defined as progression to ipsilateral revision surgery, and associated patient-specific risk factors for failure.
  
  
  METHODS
  A national database was used to identify patients undergoing surgical treatment of lateral epicondylitis from 2005 to 2012. Patients undergoing concomitant procedures were excluded. Patients who then required subsequent ipsilateral extensor carpi radialis brevis débridement or release within 2 years were identified using similar methods. A multivariate binomial logistic regression analysis was used to evaluate patient-related risk factors for revision surgery. In addition, the number of preoperative injections (1, 2, or ≥3) in the ipsilateral elbow was identified and included in the regression analysis. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor.
  
  
  RESULTS
  Of 3863 patients who underwent operative treatment of lateral epicondylitis, 58 (1.5%) required ipsilateral revision surgery. Risk factors for revision surgery included age <65 years (OR, 2.95; P = .003), male gender (OR, 1.53; P = .017), morbid obesity (OR, 2.13; P = .002), tobacco use (OR, 1.87; P < .001), and inflammatory arthritis (OR, 1.79; P = .009). Having ≥3 ipsilateral preoperative injections was the most significant risk factor (OR, 3.55; P < .001), whereas having 2 (OR, 1.44; P = .135) or 1 (OR, 1.15; P = .495) was not significant.
  
  
  CONCLUSIONS
  The incidence of failure requiring revision surgery for lateral epicondylitis in the studied population is low (1.5%). Risk factors for revision surgery include younger age, male gender, morbid obesity, tobacco use, and inflammatory arthritis. The most significant risk factor for revision surgery is having ≥3 ipsilateral preoperative injections.
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Degen
authors.affiliation: Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Jourdan M
authors.initials: JM
authors.lastname: Cancienne
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Camp
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
authors.affiliation: Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: bcw4x@virginia.edu.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000150:complications; D003646:Debridement; D005260:Female; D005542:Forearm; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D009767:Obesity, Morbid / Q000150:complications; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D013716:Tennis Elbow / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: lateral epicondylitis; risk factor; surgery; tendinopathy; tennis elbow; treatment