Systematic review of surgical techniques for medial epicondylitis: evaluating the impact of preoperative injections and concomitant ulnar neuritis on postoperative outcomes.

Introduction: Surgical intervention for medial epicondylitis (ME) is indicated when conservative management fails. This review evaluates different surgical techniques for management of ME in terms of patient-reported outcomes (PROs) and complication rates with a focus on the prognostic implications of preoperative injections and concomitant ulnar neuritis on postoperative outcomes.

Methods: Major medical databases were searched for relevant ME studies published between 2000 and September 2023. Case reports, reviews, abstract-only studies and pre-2000 studies were excluded. Two independent reviewers assessed the databases. A best evidence synthesis using Methodological Index for Non-Randomised Studies (MINORS) criteria summarised findings because of study heterogeneity.

Findings: Seventeen surgical studies (442 patients) met the inclusion criteria; most were retrospective (14 studies). MINORS scores ranged from 3 to 14, indicating variable methodological quality. Weighted means showed significant postoperative PRO improvements (p > 0.05). The overall complication rate was 3.1%, with percutaneous techniques showing 0% complications vs 6.4% for arthroscopic release and 11.1% for ulnar nerve transposition. Median time to surgery was 6 months of failed nonoperative treatment. Two studies found minimal impact of preoperative ulnar neuritis on outcomes. One of four studies assessing preoperative injections found a significant negative correlation with outcomes.

Conclusions: This review highlights a scarcity of high-quality research on surgical ME management. Nevertheless, surgical treatment for recalcitrant cases shows promising outcomes with low complication rates, particularly for percutaneous techniques. The evidence suggests that neither preoperative injections nor pre-existing ulnar neuritis significantly affects postoperative outcomes in patients undergoing surgery for ME.