In this article, we retrospectively review cases of resistant lateral epicondylitis (tennis elbow) and compare treatment with open release versus arthroscopic release. From 1997 to 2002, 87 patients were treated: 54 with open procedures and 33 with arthroscopic procedures. Seventy-five patients were available for follow-up. Mean duration of preoperative symptoms was 16 months for open cases and 22 months for arthroscopic cases. All patients had a minimum of 6 months of conservative treatment before surgery. Results showed no significant difference in outcomes. For example, 69% of open cases and 72% of arthroscopic cases had good or excellent outcomes. Notably, patients treated with arthroscopic release returned to work earlier than patients treated with open release did, and they required less postoperative therapy.