Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.MethodsA comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.ResultsThree studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was ‘low’ or ‘moderate’ on the basis of GRADE approach.ConclusionsBased on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore, more high-quality randomized controlled trials with standardized clinical improvement metrics are required to further clarify this topic and to provide reproducible pre- and postoperative objective outcomes.

Ulnar Nerve Neuropathy Secondary to “Snapping Triceps Syndrome”

“…Multiple operative solutions exist for cubital tunnel syndrome but none have been shown to be significantly superior in the short-or long-term with regard to complications or clinical resolution of symptoms. [21][22][23][24][25][26][27] Some authors have suggested that a custom intraoperative approach should be tailored to each individual patient based on their own anatomy. 28 Unusual findings like those presented in this report further support a tailored intraoperative approach.…”

Entrapment of the ulnar nerve in cubital tunnel by free intra-articular body—a case report

“…The decision to perform a submuscular transposition was made because of thickening of the nerve and osteoarthrosis changes caused by elbow fracture-dislocation, which could be a risk factor for early recurrence of ulnar nerve entrapment. Furthermore, the literature does not provide conclusive evidence either for or against any technique, 9 so anterior submuscular transposition was performed according to the surgeon's preference.…”

Evaluation of surgical methods for treatment of cubital tunnel syndrome - statistical perspectives

“…Although various rating systems for improvement exist, these have not been universally adopted. 21 A reliable and well-validated composite measure could be constructed using "Area under the Receiver Operating Characteristic" (ROC) curve. 22 Composite measure 23 in statistics and research design refer to combining multiple individual measures of various outcome parameters 24 that are assumed to be associated with variation in diagnostic accuracy.…”