Lateral Epicondylitis With Soft Tissue Atrophy Due to Repeated Corticosteroid Injections: Comparison of Open and Arthroscopic Surgery

Background: Lateral epicondylitis (LE) is commonly treated with corticosteroid injections, which may lead to atrophy of the skin and subcutaneous fat. Surgical intervention becomes necessary in refractory cases, yet the optimal approach in patients with injection-induced soft tissue atrophy remains unclear. Hypothesis/Purpose: This study aimed to compare clinical outcomes and wound-related complications between arthroscopic and open extensor tendon release in patients with LE complicated by corticosteroid-induced soft tissue atrophy. It was hypothesized that the arthroscopic technique would result in superior outcomes and fewer wound-related complications. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed a prospectively collected database of patients who underwent arthroscopic or open extensor tendon release for LE between 2018 and 2024. Inclusion criteria were refractory LE for ≥6 months, visible corticosteroid-related skin and subcutaneous atrophy, and ≥12 months of follow-up. Patients with previous elbow surgery or additional pathologies were excluded. Functional outcomes (Mayo Elbow Performance Score [MEPS] and Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]) and complication rates were compared. Results: In total, 59 patients were included (arthroscopic: n = 32; open: n = 27). Preoperative demographics and scores were similar between groups (P≥ .272). At a mean 44-month follow-up, the arthroscopic group showed significantly better postoperative MEPS (91.4 ± 3.6 vs 88.8 ± 3.8, P = .009) and QuickDASH scores (14.4 ± 6.4 vs 20.4 ± 9.6, P = .006). Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state thresholds were met by a significantly greater proportion of patients in the arthroscopic group across both scoring systems. Wound-related complications occurred in 4 open cases versus none in the arthroscopic group (P = .039). Poor clinical outcomes were more frequent in the open group, although not statistically significant (P = .084). Conclusion: Arthroscopic release provided superior functional outcomes and significantly fewer wound complications compared to open surgery in patients with LE who have corticosteroid-induced soft tissue atrophy.