Surgical management of recalcitrant lateral epicondylitis: indications, techniques, and outcomes

Lateral epicondylitis is a common cause of lateral elbow pain. Although most patients improve with nonoperative treatment, a subset develops persistent symptoms requiring surgical intervention. Various surgical techniques-including open and arthroscopic debridement, percutaneous tenotomy, and tendon repair-have been described; however, the optimal surgical strategy remains controversial. This review summarizes current evidence regarding surgical techniques and clinical outcomes, with particular emphasis on the role of tendon repair in patients with high-grade common extensor tendon tears. Overall, surgical treatment yields satisfactory outcomes, with success rates exceeding 80%-90%. Increasing evidence suggests that the severity of tendon tearing plays an important role in surgical decision-making. In particular, tears involving ≥50% of tendon thickness appear to represent a clinically meaningful threshold for considering tendon repair rather than debridement alone.