scholarly journals Type VIII Slap Repair: Patient-Reported Outcomes Of 34 Patients With Minimum 4-year Follow-up

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0017
Author(s):  
Justin W. Arner ◽  
Mitchell Stephen Fourman ◽  
Steven Bayer ◽  
Darren L. De SA ◽  
Dharmesh Vyas ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Surgical Repair ◽  
Return To Sport ◽  
Functional Score ◽  
Short Term ◽  
Type Viii ◽  
Slap Repair ◽  
Patient Reported

Objectives: Type VIII superior labrum anterior posterior (SLAP) tears - described as SLAP II injuries with posterior extension of the labral tear to the 6 o’clock aspect of the glenoid - have been shown in short-term outcome work to be a source of noted shoulder instability, pain, and reduced function/range of motion in both throwing and non-throwing athletes. Limiting our evaluation and effective treatment of these injuries in both the professional athlete and weekend warrior is our lack of mid- and long-term post-operative outcomes after surgical repair. It is hypothesized that Type VIII SLAP repairs would fare poorly, particularly in the throwing cohort, at mid- to long-term follow-up. Methods: With a minimum 4-year follow-up after Type VIII SLAP repair by a single surgeon, return to sport, KJOC, ASES, stability, range of motion, and pain were compared between throwers, contact, and non-contact athletes. Results: With an average follow-up of 6.2 years, 34 athletes (19 throwers, 5 contact athletes, 10 non-contact athletes), with a mean age of 24.4 years were evaluated. Significant (p < .0001) improvements were observed between pre- and post-operative pain, range of motion, and ASES total and functional scores in throwers and non-throwers. Stability improved but was not significant (Table 1). There were no post-operative differences between throwers and non-throwers (Table 2). Pre-operative ASES functional score was significantly lower in contact athletes than in throwers and non-contact athletes (p < .01), but post-operatively improved significantly with no difference between groups (Table 3, 4). Overall, there was no difference in return to sport between groups as 73.7% of throwers and 93.3% of non-throwers returned (Table 4) and 62.5% of throwers and 57.9% of non-throwers (p = .73) returned to the same level. Further, 89.5% of throwers and 100% of non-throwers (p = .49) said that their surgery was worthwhile. Conclusion: Given the paucity of literature, current surgical outcomes of athletes who have undergone Type VIII SLAP repairs is limited, particularly in mid- and long-term function and return to sport. The current findings suggest that surgical repair of Type VIII SLAP lesions contributes to significant improvements in pain, function, and shoulder range of motion that persists >4 years after repair. However, stability changes after injury appear more chronic in nature. Further, thrower and non-throwers appear to have similar outcomes, which has not previously been seen in short term studies. [Table: see text][Table: see text][Table: see text][Table: see text]

scholarly journals Biceps Tenodesis is a Viable Option for Management of Proximal Biceps Injuries in Patients Less Than 25 Years of Age

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0011 ◽  
Author(s):  
Justin W. Griffin ◽  
Gregory L. Cvetanovich ◽  
Jonathan Charles Riboh ◽  
Timothy Sean Leroux ◽  
Bernard R. Bach ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Young Patients ◽  
Return To Sport ◽  
Activity Level ◽  
Functional Score ◽  
Biceps Tenodesis ◽  
Overhead Athletes ◽  
Additional Surgery

Objectives: Biceps tenodesis has been proposed as an alternative to superior labral anterior posterior (SLAP) repair in older individuals, and there is evidence to suggest it is a reliable operation with low failure rate in these patients. Despite this, there has been some trepidation to adopt this in young active patients due to concern for altered postoperative glenohumeral kinematics and stability. To date no studies have examined younger individuals less than 25 undergoing proximal biceps tenodesis as an intervention for proximal biceps related pain and dysfunction. Methods: Between February 2011 and February 2013, 45 consecutive patients underwent biceps tenodesis for a diagnosis of biceps tendinopathy or biceps-labral complex injuries including SLAP tears and those with at least two-year follow up were analyzed. Thirty-five patients (77%), with a mean age of 19.8 ± 2.5 years were available for follow-up at a mean of 38.6 ± 9.5 months postoperatively. Functional outcomes were assessed with Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) Score, ASES Functional Score, Simple Shoulder Test (SST), and range of motion (ROM). Patient activity level and return to sport was followed postoperatively. Pre and postoperative scores were compared utilizing paired t-tests between groups. Results: 35 patients less than 25 years of age underwent biceps tenodesis and were available for follow up at two years (77%). 33 of 35 patients were athletes with 15 patients playing at the collegiate level with softball and baseball representing the most common sports. 22 patients were overhead athletes. 16 patients had no prior shoulder surgery with 19 representing revision shoulder procedures. Overall, mean VAS improved from 5.0 ± 1.2 to 2.0 ± 1.1 (p<0.0001). All clinical outcome scores improved with ASES score improving from 54.7 to 81.7 (mean difference 27.0±3.7, 95% CI 19.5,34.6), (p<0.0001), ASES functional score improved from 17.5 to 25.1 (7.5±1.2, 95% CI 5.0,10.0) (p<0.001), and SST improved from 7.4 to 10.1 (2.7±0.5, 95% CI 1.7,3.7) (p<0.0001). Range of motion was maintained postoperatively. Patients with higher BMI trended toward less improvement in function (p=0.0854) and SST (p=0.0355). At the time of follow-up, four patients (11%) had undergone revision surgery. 22 of 33 (66%) patients returned to sports with 16 returning at the same level and 6 at a lower level of play. 16 of 21 (76%) overhead athletes return to sport with 4 requiring additional surgery after biceps tenodesis. There was no difference in scores for overhead versus nonoverhead athletes. Conclusion: In the present study, biceps tenodesis in patients less than 25 years of age yields excellent outcomes with two thirds of patients able to return to sport. Additionally, we found a low revision rate. Of note, BMI appears to be a risk factor for a negative outcome following biceps tenodesis. Future long-term multicenter comparative studies with long term follow up are needed to demonstrate durability of biceps tenodesis in young patients.

Evaluation of Long-term Outcomes Following Plantar Fasciotomy

2018 ◽  
Vol 39 (11) ◽  
pp. 1312-1319 ◽  
Author(s):  
Rebekah Gibbons ◽  
Katherine E. Mackie ◽  
Todd Beveridge ◽  
Dana Hince ◽  
Peter Ammon
Keyword(s):  
Patient Satisfaction ◽  
Plantar Fasciitis ◽  
Satisfaction Score ◽  
Satisfaction Survey ◽  
Long Term Outcomes ◽  
Short Term ◽  
Patient Reported ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is a common condition prevalent in both athletic and nonathletic populations. Approximately 10% of patients do not respond to conservative treatment and suffer chronic recalcitrant plantar fasciitis. Outcomes following plantar fasciotomy vary but short-term studies have reported excellent early pain relief and return to activity, and significant improvements in symptoms. Previous study limitations include small patient cohorts, short-term duration of follow-up or lack of validated outcome measures. We therefore aimed to investigate the long-term outcomes following complete plantar fasciotomy. Methods: Patients who underwent complete plantar fasciotomy surgery from a single surgeon within the past 10 years (minimum 7 months) were invited to participate in this retrospective survey study. To evaluate patient-reported function, participants were asked to complete the Foot and Ankle Outcome Score (FAOS). To assess subjective outcome, the participants were provided a satisfaction survey. The satisfaction survey was designed to include the 3 key factors for assessing postoperative patient satisfaction, which are preoperative expectations, symptom relief, and hospital experience. A total of 74 questionnaires were returned. Results: The median global satisfaction score was 85.4 (IQR=37.5) points out of 100. Significant correlations between the global patient satisfaction score and all FAOS subscale scores were identified. Only 3 participants (4%) reported a complication following surgery; however, 32 participants (44.4%) indicated that they still experienced swelling and/or tenderness in their foot at the time of the survey (mean follow-up time 4.8 ± 2.8 years) but for the majority of patients this was improved from before surgery. Conclusion: Long-term patient satisfaction was experienced by the majority of patients following plantar fasciotomy. Although 44% of patients continue to have postoperative complaints, 73% indicated that they were satisfied with their symptoms postoperatively, and 74% would undergo a similar procedure again. Level of Evidence: Level IV, case series.

LONG TERM FOLLOW-UP AFTER FINGER REPLANTATION

2008 ◽  
Vol 33 (1) ◽  
pp. 59-64 ◽  
Author(s):  
I. WALASZEK ◽  
A. ZYLUK
Keyword(s):  
Blood Flow ◽  
Range Of Motion ◽  
Grip Strength ◽  
Long Term Results ◽  
Functional Score ◽  
Pinch Grip ◽  
Active Range Of Motion ◽  
Long Term Follow Up

The aim of this retrospective study was to assess objective and subjective aspects of the long-term results of finger replantations and revascularisations. Forty patients with 59 successfully replanted or revascularised fingers, who had a mean age of 38 years, were followed-up over an average of 3.5 years. The assessment included: the profile of the blood flow in the digital arteries of replanted fingers with Doppler ultrasound, active range of motion, total grip strength, pinch grip, static two-point discrimination test and Semmes–Weinstein monofilament testing. The dexterity of the hand was evaluated subjectively with the Carlsson’s questionnaire and cold intolerance with a modified McCabe’s questionnaire. Statistical analysis was performed and a statistically significant correlation was found between the Carlsson’s functional score, active range of motion and total grip strength. In 28 fingers (74%), blood flow in the digital arteries showed an undisturbed profile, while ten fingers showed mild stenosis or impaired microcirculation.

scholarly journals Assessment of patient-reported outcomes after polytrauma: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017571 ◽  
Author(s):  
Irmela Gnass ◽  
Michaela Ritschel ◽  
Silke Andrich ◽  
Silke Kuske ◽  
Kai Moschinski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Short Term ◽  
Patient Reported

IntroductionSurvivors of polytrauma experience long-term and short-term burden that influences their lives. The patients’ view of relevant short-term and long-term outcomes should be captured in instruments that measure quality of life and other patient-reported outcomes (PROs) after a polytrauma. The aim of this systematic review is to (1) collect instruments that assess PROs (quality of life, social participation and activities of daily living) during follow-up after polytrauma, (2) describe the instruments’ application (eg, duration of period of follow-up) and (3) investigate other relevant PROs that are also assessed in the included studies (pain, depression, anxiety and cognitive function).Methods and analysisThe systematic review protocol is developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials and the trials registers ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. Keywords, for example, ‘polytrauma’, ‘multiple trauma’, ‘quality of life’, ‘activities of daily living’ or ‘pain’ will be used. Publications published between January 2005 and the most recent date (currently: August 2016) will be included. In order to present the latest possible results, an update of the search is conducted before publication. The data extraction and a content analysis will be carried out systematically. A critical appraisal will be performed.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be published in a peer-reviewed publication.PROSPERO registration numberCRD42017060825.

Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

2019 ◽  
Vol 47 (9) ◽  
pp. 2151-2157 ◽  
Author(s):  
Joseph N. Liu ◽  
Anirudh K. Gowd ◽  
Grant H. Garcia ◽  
Brandon J. Manderle ◽  
Alexander Beletsky ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Bench Press ◽  
Case Series ◽  
Return To Sport ◽  
Pectoralis Major ◽  
Functional Score ◽  
Repetition Maximum ◽  
Number Of Patients ◽  
Patient Reported

Background: The use of routine patient-reported outcomes after repair of the pectoralis major tendon (PMT) is often prone to the ceiling effect owing to the high functional demand of those who sustain this injury. Hypothesis: A significant number of patients are expected to fail to achieve return to preoperative activity after PMT repair despite achieving significant improvements in functional score. Study Design: Case series; Level of evidence, 4. Methods: A prospectively maintained institutional database was reviewed for all patients undergoing PMT repair from 2010 to 2016. Patients were surveyed with regard to pre- and postoperative participation in sports, level of intensity, maximum weight repetitions in exercises utilizing the PMT, and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Results: Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean ± SD follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 years (range, 24-61 years), and mean body mass index was 28.6 ± 3.5 kg/m2. The dominant side was affected in 20 of 44 cases. Acute repairs were performed in 30 cases and chronic in 14. There were statistically significant improvements in both ASES and SANE scores ( P < .001). Return to sport at any level was achieved by 43 of 44 (97.7%) patients, while 22 of 44 patients (50.0%) reported returning to sport at the same or better intensity as preinjury status. On average, there was a 23.3% ± 45.6% decrease in 1–repetition maximum (1RM) barbell bench press, 14.7% ± 62.3% decrease in 5–repetition maximum barbell bench press, 24.3% ± 21.8% decrease in 1RM dumbbell bench press, 35.7% ± 32.1% decrease in 1RM dumbbell fly, and 15.6% ± 39.8% decrease in consecutive push-ups able to be performed. Seventeen patients (38.6%) reported a degree of apprehension that affected their ability to lift weights. When all preoperative variables were accounted for, history of surgery to the contralateral shoulder (odds ratio, 0.600; 95% CI, 0.389-0.925) was associated with a decreased likelihood of returning to sport at the same or better level of intensity, while injury sustained during sport had a greater likelihood (odds ratio, 2.231; 95% CI, 1.234-4.031). Conclusion: Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. Yet, only 50% are able to return to preoperative intensity of sport, and they will also have significant reductions in their ability to weight lift.

scholarly journals Increased disease activity in early arthritis patients with anti-carbamylated protein antibodies

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cristina Regueiro ◽  
Laura Nuño ◽  
Ana Triguero-Martinez ◽  
Ana M. Ortiz ◽  
Alejandro Villalba ◽  
...  
Keyword(s):  
Disease Activity ◽  
Early Arthritis ◽  
Prognostic Biomarkers ◽  
Short Term ◽  
Initial Management ◽  
Appropriate Treatment ◽  
Patient Reported ◽  
Activity Measures

AbstractThe initial management of rheumatoid arthritis (RA) has a high impact on disease prognosis. Therefore, we need to select the most appropriate treatment as soon as possible. This goal requires biomarkers of disease severity and prognosis. One such biomarker may be the presence of anti-carbamylated protein antibodies (ACarPA) because it is associated with adverse long term outcomes as radiographic damage and mortality. Here, we have assessed the ACarPA as short-term prognostic biomarkers. The study was conducted in 978 prospective early arthritis (EA) patients that were followed for two years. Our results show the association of ACarPA with increased levels of all the disease activity measures in the first visit after arthritis onset. However, the associations were more significant with the high levels in local measures of inflammation and physician assessment than with the increases in systemic inflammation and patient-reported outcomes. More notably, disease activity was persistently increased in the ACarPA positive patients during the two years of follow-up. These differences were significant even after accounting for the presence of other RA autoantibodies. Therefore, the ACarPA could be considered short-term prognostic biomarkers of increased disease activity in the EA patients.

scholarly journals Surgical Repair of Distal Triceps Tendon Injuries: Short-term to Midterm Clinical Outcomes and Risk Factors for Perioperative Complications

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983999 ◽  
Author(s):  
Brian R. Waterman ◽  
Robert S. Dean ◽  
Shreya Veera ◽  
Brian J. Cole ◽  
Anthony A. Romeo ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Functional Outcomes ◽  
Surgical Repair ◽  
Perioperative Complications ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Short Term ◽  
Patient Reported ◽  
Triceps Tendon

Background: Few large-scale series have described functional outcomes after distal triceps tendon repair. Predictors for operative success and a comparative analysis of surgical techniques are limited in the reported literature. Purpose: To evaluate short-term to midterm functional outcomes after distal triceps tendon repair in a broad patient population and to comparatively evaluate patient-reported outcomes in patients with and without pre-existing olecranon enthesopathy while also assessing for modifiable risk factors associated with adverse patient outcomes and/or revision surgery. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective analysis of 69 consecutive patients who underwent surgical repair of distal triceps tendon injuries at a single institution. Demographic information, time from injury to surgery, mechanism of injury, extent of the tear, pre-existing enthesopathy, perioperative complications, and validated patient-reported outcome scores were included in the analysis. Patients with a minimum of 1-year follow-up were included. Results: The most common mechanisms of injury were direct elbow trauma (44.9%), extension/lifting exercises (20.3%), overuse (17.4%), and hyperflexion or hyperextension (17.4%). Eighteen patients were identified with pre-existing symptomatic enthesopathy, and 51 tears were caused by an acute injury. A total of 36 complete and 33 partial tendon tears were identified. Bone tunnels were most commonly used (n = 30; 43.5%), while direct sutures (n = 23; 33.3%) and suture anchors (n = 13; 18.8%) were also used. Perioperative complications occurred in 21.7% of patients, but no patients experienced a rerupture at the time of final follow-up. No statistically significant relationship was found between patient age ( P = .750), degree of the tear ( P = .613), or surgical technique employed ( P = .608) and the presence of perioperative complications. Conclusion: Despite the heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series found favorable functional outcomes and no cases of reruptures at short-term to midterm follow-up. Furthermore, age, surgical technique, extent of the tear, and mechanism of injury were not associated with adverse patient outcomes in this investigation. Pre-existing triceps enthesopathy was shown to be associated with increased complication rates.

scholarly journals TL 18050 - Short-term complications, reoperations, and radiographic outcomes of Infinity® total ankle arthroplasty

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 64S
Author(s):  
Guilherme Honda Saito ◽  
Austin Sanders ◽  
Cesar Cesar Netto ◽  
Martin O'Malley ◽  
Scott Ellis ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Short Term ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Outcome Scores

Introduction: With the increasing use of total ankle arthroplasty (TAA), new implants with varied configurations are being developed every year. This study aimed to assess the early complications, reoperations, and radiographic and clinical outcomes of this novel implant. Methods: A retrospective analysis of 64 consecutive ankles that underwent a primary Infinity® TAA was performed. Patients had an average follow-up of 24.5 (range, 18-39) months. Medical records were reviewed to determine the incidence of complications, reoperations, and revisions. Additionally, patient-reported outcomes were analyzed with the Foot and Ankle Outcome Score (FAOS). Results: Survivorship of the implant was 95.3%. Fourteen ankles (21.8%) presented a total of 17 complications. A total of 12 reoperations were necessary in 11 ankles (17.1%). Revision surgery was indicated for 3 ankles (4.7%) as a result of subsidence of the implant. Tibiotalar coronal deformity was significantly improved after surgery (P < .0001) and maintained at the latest follow-up (P = .81). Periprosthetic radiolucent lines were observed around the tibial component in 20 ankles (31%) and around the talar component in 2 ankles (3.1%). A tibial cyst was observed in 1 ankle (1.5%). Outcome scores were significantly improved for all FAOS components analyzed (P < .0001). Conclusion: Most complications observed in the study were minor and successfully treated with a single reoperation procedure or nonoperatively. Failures and radiographic abnormalities were most commonly related to the tibial implant. Further studies with longer follow-ups are needed to evaluate the survivorship of the tibial implant over the long term.

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

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