Derek Ochiai

Nirschl Surgical Technique for Concomitant Lateral and Medial Elbow Tendinosis: A Retrospective Review of 53 Elbows With a Mean Follow-up of 11.7 Years

Background: Combined lateral elbow tendinosis (tennis elbow) and medial elbow tendinosis (golfer’s elbow) can be a disabling condition that, if unresponsive to nonoperative treatments, may be effectively treated surgically. The authors are not aware of any study that reports the outcome of a combined operation for lateral and medial elbow tendinosis (country club elbow) performed in the same operative setting. Hypothesis: Combined surgical treatment of country club elbow in the same operative setting has similar outcomes to those seen in the literature for single operative procedures. Study Design: Case series; Level of evidence 4. Methods: Outcome measurements included the Numeric Pain Intensity Scale, the Nirschl tennis elbow scoring system, and the American Shoulder and Elbow Surgeons elbow form. Forty-eight patients (53 clinical elbows) were available by telephone, with a minimum time to follow-up of 5 years (range, 5-19 years; mean, 11.7 years). Results: The average Nirschl tennis elbow score improved from 16.7 preoperatively to 70.8 postoperatively (P < .01). The average American Shoulder and Elbow Surgeons elbow score improved from 45.2 to 90.4 (P < .01). The Numeric Pain Intensity Scale score improved from 8.8 to 1.7 (P < .01). By the criteria of the Nirschl tennis elbow score, results were rated excellent in 38 elbows, good in 7 elbows, fair in 5 elbows, and poor in 3 elbows, with 85% (45 of 53) good to excellent results. Patient satisfaction with the surgery averaged 8.7 out of 10. Of the 46 patients who played sports, 44 (96%) reported returning to their sports. Conclusion: When nonoperative treatment of lateral and medial elbow tendinosis fails, combined surgical intervention via the Nirschl operative techniques for country club elbow is highly effective, with results similar to those of single-sided intervention.

Variation in Planned Resection of CAM FAI Based on Surgeon Experience

Introduction. Currently, there are no definitive guidelines for the resection of a cam lesion. The purpose of this study was to investigate factors indicating the potential differences in low and high volume hip arthroscopists in marking the area of resection in cam lesions using X-rays for preoperative planning. Methods. Thirty-nine surgeons with varying levels of hip arthroscopy experience participated in the study. Surgeons filled out a survey and traced the area of optimal resection on radiographs with varying amounts of cam FAI. Participants were grouped by number of hip arthroscopies performed, years of surgical experience, and number of surgeries performed. Results. Surgeons who perform osteoplasty as a high percentage of their total hip surgeries per year correlate to the total number of hip arthroscopies performed per year (, ) and number of years of experience (, ). Surgeons performing greater than 50 cases per year traced a larger resection area for 3 different patients’ radiographs as compared to those performing less than 50 cases per year (117%, 143%, and 173%, ). Conclusions. This study demonstrates that surgeons with less experience (decreased number of years operating and total number of surgeries) plan for resecting less cam than do experienced surgeons.