Arthroscopic Treatment for Tennis Elbow! Report Shows Excellent Outcomes

“Tennis elbow” or lateral epicondylitis is, according to our PearlDiver database, one of the most reported diagnoses for problems with the elbow. From three million to four million patients visit doctors every year for some sort of elbow pain or injury. Of these patients approximately 1% – 3% are diagnosed with “tennis elbow.” Historically, patients diagnosed with tennis elbow were treated non-operatively and that remains the most common treatment approach. Lately, however, clinical evidence has shown that arthroscopic treatment for tennis elbow can provide long-term stability and, in most cases, return of the elbow to its optimal function.

Of patients diagnosed with tennis elbow, about 80% undergo a therapeutic or radiologic procedure. The remaining 20% are treated with open surgeries or another operative treatment. Chart 1 shows the top associated surgical procedures for tennis elbow. Radiologic and therapeutic codes have been excluded from the analysis to give a better picture of the surgical treatments for tennis elbow.

Chart 1: Associated Surgical Procedures for Tennis Elbow

Source: PearlDiver Patient Records Database, January 2004 - June 2007

Arthroscopic treatment of tennis elbow is fairly new and doesn’t yet register as one of the top surgical treatments. However, surgeons who have been performing arthroscopic treatments have many good things to say about it.

A medical study presented by Dr. Champ L. Baker III, an orthopedic resident at the University of Pittsburgh, at the 2007 Annual Meeting of the American Orthopaedic Society for Sports Medicine at the Telus Convention Center in Calgary, Canada, was the “first longitudinal study of arthroscopic treatment of tennis elbow”. It showed that such a treatment could be both successful for lingering tennis elbow and provide consistent long-term patient benefit. Other advantages to arthroscopic surgery, according to Baker, are that it speeds up rehabilitation and results in fewer complications when compared to other operative measures such as injection or arthrocentesis.

Table 1 below shows the number of and type of arthroscopic treatments for tennis elbow in the PearlDiver database from January 2004 through June 2007. Arthroscopic debridement, considered by many surgeons to be the best treatment for tennis elbow, was the most performed procedure.

Table 1: Arthroscopic Procedures for Treating Tennis Elbow
January 2004 – June 2007

Note: Shaded box represents January - June 2007
Source: PearlDiver Patient Records Database, January 2004 - June 2007

While the charges for the various procedures are similar to each other, the average charge for arthroscopic surgical treatment with debridement is the most costly, at $2,725.

Table 2: Average Charges of Arthroscopic Treatments for Tennis Elbow
January 2004 – June 2007

Source: PearlDiver Patient Records Database, January 2004 - June 2007

Dr. Kenneth Montgomery, New York Jets’ Head Physician

Dr. Kenneth Montgomery is an orthopedic surgeon who specializes in the care of traumatic and sports-related injuries of the upper extremities. He also performs arthroscopic and minimally invasive surgery at Tri-County Orthopaedics in New Jersey is a team physician for the New York Islanders hockey team, a tournament physician for the U.S. Open Tennis Tournament, and Head Team Physician for the New York Jets football team. In an interview with PearlDiver analysts, Dr. Montgomery stated that arthroscopic treatment was the ideal treatment for patients with severe tennis elbow. He pointed out that arthroscopic treatment is minimally invasive, is less painful and requires less rehabilitation time for patients than do other procedures.

The traditional and conservative operative treatment for tennis elbow has been an open surgical repair of the joint. According to Dr. Montgomery, this treatment remains appropriate for those patients on whom multiple procedures have already been performed or for those few patients who have received arthroscopic treatment which, for some reason, was not successful. He reports that, in the United States, about 90% of patients with tennis elbow continue to undergo the traditional open surgery while 10% receive the arthroscopic repair.

Dr. Montgomery is fully in accord with Dr. Baker’s study and predicts that, with time, the number of surgeons performing arthroscopic treatments will rise and the techniques will improve. Dr. Montgomery urges patients whose elbow pain has not responded well to non-operative treatments to consult with an arthroscopic specialist. He points out that this treatment is much improved and is far quicker than a long and complicated open repair of the joint.

Market Penetration

The size of the market for arthroscopy, now used to treat all areas of the body from shoulders to knees and from wrists to ankles, is growing at a rate of 4% – 5% a year. In 2006 the US arthroscopic market was close to $950 million and is estimated to have reached the billion-dollar mark in 2007. The arthroscopic market’s biggest revenue generators have been shoulder and knee procedures. ConMed and Smith & Nephew hold the largest arthroscopic market shares in the United States. They are ranked among the top five companies in the arthroscopic market in the U.S. and worldwide.

Lateral epicondylitis (tennis elbow) is emerging as a growing market in the orthopedic industry. According to the PearlDiver estimates, tennis elbow represents almost 4% of the extremities patient population. Between January 2004 and June, 2007, the number of patients receiving a “tennis elbow” diagnosis has risen by 25%. Between January 2004 and June 2007, the number of tennis elbow patients treated with arthroscopy grew almost 48% according to the PearlDiver database. Like the shoulder market, which saw tremendous growth in its arthroscopic rotator cuff market in recent years, the arthroscopic market for tennis elbow appears to be headed for robust growth.