Open and arthroscopic debridement for lateral epicondylitis: a systematic review and meta-analysis based on comparative studies

Objectiv To systematically compare and meta-analyse the clinical efficacy of open and arthroscopic debridement for patients with lateral epicondylitis. Methods A retrieval and systematic review of comparative studies of lateral epicondylitis treated with open versus arthroscopic debridement was conducted, and further pooled analysis was performed to compare the overall differences in clinical outcomes, including pain and elbow function scores, surgical time, complications and revision surgery rate. Results A total of 10 comparative studies involving 20,060 patients with lateral epicondylitis who were followed up for 12-93.6 months were included. Preliminary meta-analysis revealed that the visual analogue scale (VAS) score for pain was greater in the arthroscopic group than in the open group (MD: 0.01 [- 0.27-0.29], p = 0.93; I-2 = 0%, p = 0.98). Additionally, the Disabilities of the Arm, Shoulder and Hand (DASH) and quickDASH scores were worse in the arthroscopic group than in the open group (MD: 0.59[- 1.01-2.20], p = 0.47; I-2 = 68%, p = 0.02), and the surgical time was significantly longer in the arthroscopic group than in the open group (MD: 13.36[12.42-14.29], p < 0.00001; I-2 = 98%, p < 0.00001). There were not significant differences of complication rate, revision surgery rate between the arthroscopic group and the open group (RR: 0.82 [0.54-1.25], p = 0.36; I-2 = 0%, p = 0.80; RR: 1.30 [0.90-1.88], p = 0.16; I-2 = 0%, p = 0.76). Radial nerve injury represented the most prevalent complication within the arthroscopy group, and its incidence was slightly higher in the arthroscopic group compared to the open group [0.46% (12/2562) VS 0.33% (58/17409), X-2 = 1.169, p = 0.281]. Conclusions In this systematic review and meta-analysis, we did not observe any significant advantage of arthroscopic debridement over open debridement in the treatment of lateral epicondylitis, but the surgical duration was significantly longer in the arthroscopic group, and we could assume that arthroscopic debridement may be more expensive. It was important to highlight that radial nerve injury represented the most prevalent complication within the arthroscopy group, which suggested that arthroscopic procedures for lateral epicondylitis should be performed in experienced hands. Therefore, the decision between arthroscopic and open debridement should take into account various factors, including the advantages of minimally invasive techniques, cost-benefit analysis, potential complications, and the surgeon's level of expertise.