Evolution of arthroscopic treatment from intracapsular to extracapsular for patients with refractory tennis elbow: A mixed-method study.

Abstract Background Arthroscopic surgery is widely used in the treatment of refractory tennis elbow due to its advantages of minimally invasive, safe and direct vision. Intra-capsular arthroscopy(intracapsular method), which is performed via natural cavity, is the mainstream arthroscopic procedure. However, intracapsular method requires the damage of joint capsule and may cause intraoperative neurovascular injury and other complications. In view of the defects of intracapsular method, the surgical scheme of the extracapsular arthroscopy (referred to as "extracapsular method") has emerged. The aim of this study was to investigate the exploration history, key theories, methods, and techniques involved in the evolution from the intracapsular method to the extracapsular method for arthroscopic treatment of tennis elbow, and explore the effectiveness and safety of extracapsular method. Methods Qualitative data were collected via focus group interview. 7 surgeons who were selected through purposive sampling discussed on the theories, methods, and technical specifications of the transition from intracapsular method to extracapsular method. Qualitative data were analysed using NVivo11. Quantitative data of consecutive 43 patients were analysed to evaluate the effectiveness and safety of the extracapsular method. Descriptive analysis was conducted to analyse the demographic characteristics and clinical outcomes after surgery. Results The experts agreed that the extracapsular method maintains the integrity of joint capsule and avoids complications caused by joint capsule damage. Extracapsular method was considered easy for surgeons to master and convenient to operate. Technical specifications for extracapsular method were formed based on group discussion. The median time for pain relief and recovery of daily activities of 43 patients treated with these specifications were 3 months and 6 weeks, respectively. The satisfaction rates of Mayo Elbow Performance Scores were 87.2%, 95.6%, and 100% respectively at 3, 6, and 12 months after operation. Conclusion On the basis of international peer innovation, the extracapsular method has been continuously developed in our clinical practice to avoid the possible complications of the intracapsular method. The resulting technical specifications have been shown to have good clinical efficacy and safety in a small sample cohort.