Carpal tunnel release with versus without flexor retinaculum reconstruction for carpal tunnel syndrome at short- and long-term follow up—A meta-analysis of randomized controlled trials

Abstract

BackgroundCarpal tunnel syndrome is a common neuropathy disorder for which surgical treatment consists of release and reconstruction of the flexor retinaculum. Reports of postoperative clinical outcomes after carpal tunnel release with or without flexor retinaculum reconstruction in several studies are controversial. This meta-analysis aimed to compare the efficacy and safety of carpal tunnel release with or without flexor retinaculum reconstruction.MethodsThe PubMed, EMBASE, Web of Science, Ovid, Cochrane Library and Clinical Tri Org databases were searched for randomized controlled trials that compared carpal release with and without transverse carpal ligament reconstruction for carpal tunnel syndrome. Outcomes included postoperative Boston Carpal Tunnel Questionnaire Symptom Severity Scale (SSS), Functional Status Scale (FSS), grip strength and complications. The follow-up time was categorized into short-term (0-3mon) and long-term(>3mon).ResultsA total of 7 studies with 613 patients met the inclusion criteria and were analyzed in detail. Statistical analysis showed no significant difference between two groups on postoperative long-term grip strength (MD 5.85, 95% CI -1.05 to 12.76) long-term SSS (MD -0.31, 95% CI -0.75 to 0.13) and occurrence of complications (RR 1.14, 95% CI 0.84 to 1.54), whereas statistically significant difference was found between groups regarding short-term grip strength (MD 1.51, 95% CI 0.86 to 2.17) and long-term FSS (MD -0.34, 95% CI -0.47 to -0.21).ConclusionCarpal tunnel release with flexor retinaculum reconstruction for carpal tunnel syndrome may result in improved long-term functional status while there’s no advantage regarding grip strength, symptom severity and safety over individual carpal tunnel release in short- and long-term outcomes.

Surgical Interventions for the Management of Carpal Tunnel Syndrome: A Narrative Review

“…Long-term functional status was noticed to be improved in the surgical release with FRR. Anyhow, no significant difference was noted between both groups who combined the surgical decompression with FRR and those who used the surgical decompression only regarding the improvement of grip strength and symptom relief in short and long-term follow-up [ 18 ]. A randomized clinical trial was conducted by Gutiérrez-Monclus et al on 117 cases of severe idiopathic CTS.…”

“…Ultrasound-guided CTR with smaller incisions was found to reduce surgery-related morbidity and speed up recovery. This procedure has numerous advantages for the patient, the hospital, and society [ 18 ]. The surgical process is brief, and it can be conducted in an outpatient ambulatory setting, boosting patient turnover.…”

Grip Strength Measurement for Outcome Assessment in Common Hand Surgeries

“…A recent systematic review suggests that CTR with TLC reconstruction group did not show a significant advantage in grip strength although there was a significant difference of grip strength in favor of the TCL reconstruction group at 3 months or less postoperatively. 29) …”

Differentialtherapeutische Herangehensweisen zur Behandlung des Karpaltunnelsyndroms

“…Auch die primäre oder sekundäre Rekonstruktion des Retikulums wurde immer wieder diskutiert, um einem Auseinanderweichen des transversalen knöchernen karpalen Bogens (Canalis carpi) [39] und sekundär gesteigerter interkarpaler Mobilität mit möglicherweise assoziierten postoperativen Griffkrafteinbußen entgegenzuwirken [40]. Eine rezente Metaanalyse konnte jedoch keinen Vorteil hinsichtlich der Griffkraft oder Symptomkontrolle nachweisen, sodass die regelhafte Rekonstruktion des Retinakulums für diesen Eingriff nicht empfohlen wird [40].…”