Instability Possible With Refractory Lateral Epicondylitis

A new study confirms that elbow instability, especially posterolateral rotatory instability, is possible with refractory lateral epicondylitis, but that clinical outcomes are still good.

In the study, “Systematic Review of Elbow Instability in Association With Refractory Lateral Epicondylitis: Myth or Fact?” the researchers conducted a systematic review to identify the risk factors, clinical and radiologic-diagnostic characteristics as well as treatment options and clinical outcome of refractory lateral epicondylitis with posterolateral rotatory instability. The systematic review was published online on January 12, 2021 in The American Journal of Sports Medicine.

While patients have reported elbow instability with refractory lateral epicondylitis, there is little data on diagnostic approach and surgical outcomes.

Using PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, Scopus, and EMBASE database, the researchers identified 6 level 4 and 2 level 3 studies that included 249 patients.

The most common causes of elbow stability were heavy labor activity (74/172; 43%) and steroid injections. Four patients had a single injection while 180 received multiple injections.

In 9% of the patients, the instability was accompanied by pain. Magnetic resonance imaging also revealed that radial collateral ligament and lateral ulnar collateral ligament lesions were most common (18/79; 23%).

According to the data collected, the most common surgical positions were arthroscopic radial collateral ligament plication (62/120; 52%) and lateral ulnar collateral ligament reconstruction (30/120; 25%).

For 64% of the patients, ligament patholaxity was observable during surgery.

Overall clinical outcomes ranged from good to excellent, the researchers reported. Limited range of motion was the most common symptom to linger after treatment.

They wrote, “Instability can coexist and may be associated with refractory lateral epicondylitis. The risk factors of instability associated with refractory lateral epicondylitis are heavy labor and multiple steroid injections. A systematic approach to identify the clinical and magnetic resonance imaging presentation of the condition followed by examination under anesthesia are necessary for affirmative diagnosis as independent presentations may be misleading.”