1. Surgical Treatment of Lateral Epicondylitis John F. Meyers, M.D.

2. A Modification of the Bosworth Procedure

3. Pathology Microtears of the ECRB

4. Pathology Angiofibroblastic Hyperplasia

5. Surgical Treatment Release of extensor aponeurosis Release of anular ligament Tendon lengthening Release of extensor aponeurosis Release of anular ligament Tendon lengthening

6. Surgical Technique Percutaneous release Arthroscopic release Percutaneous release Arthroscopic release

7. 51 elbow in 47 patients Jan 88 – April 95

8. 37 cases in 34 patients

9. Average age 48 Range 33 – 69

10. Dominant - 27 Non-Dominant – 9

11. Conservative Treatment 14.4 mos.

12. Conservative Treatment Avg. 2,7 cortisone injections

13. Surgical Technique

14. Grading – Nirschel Excellent – All activity, no pain Good – All activity, mild pain Excellent – All activity, no pain Good – All activity, mild pain

15. Grading – Nirschel Fair – Pain with heavy actiity Poor – No improvement Fair – Pain with heavy actiity Poor – No improvement

16. Results Excellent23 Good 10 Fair3 Poor1 Excellent23 Good 10 Fair3 Poor1

17. Results ROM Normal Grip Strength Normal ROM Normal Grip Strength Normal

18. Results 100% returned to work

19. Results 16/17 returned to sport

20. Complications Hypertrophy of annular ligament Neuroma Olcranon bursitis Hypertrophy of annular ligament Neuroma Olcranon bursitis

21. Results Meyers & Frix – 89% G%E

22. Results Nirschel & Pettrone 85% G&E Verhaar 69% G&E Coonrad & Hooper all satisfactory Nirschel & Pettrone 85% G&E Verhaar 69% G&E Coonrad & Hooper all satisfactory

23. Dissatisfaction Hypertrophy of annular ligament Pain with activity No improvement in symptoms Hypertrophy of annular ligament Pain with activity No improvement in symptoms

24. Conclusion Simple reproducible procedure Outpatient procedure Predictable results Simple reproducible procedure Outpatient procedure Predictable results