Does Revision Carpal Tunnel Release Result in Long-term Outcomes Equivalent to Single Carpal Tunnel Release? A Matched Case-Control Analysis.

Abstract

In the United States, approximately 600,000 patients undergo carpal tunnel release (CTR) annually for carpal tunnel syndrome (CTS). 1 CTR is an effective treatment to improve grip strength and decrease paresthesia in patients with CTS. 2,3 However, in up to 30% of patients, residual symptoms persist or recur, leading to revision surgery in up to 5%. [4][5][6][7][8][9][10][11] Although most studies suggest that the outcome after revision surgery is worse compared with single, initial CTR, some studies report outcomes comparable to single, initial CTR. [3][4][5][6]8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Nevertheless, these studies use different outcome metrics to determine a successful outcome, which makes comparison difficult. Other literature showed that factors such as age, sex, and surgical technique are associated with revision CTR, and that both relief of symptoms as well as recurrence may occur months to years after the first surgery. 5,9

Revision Carpal Tunnel Release Following Endoscopic Compared With Open Decompression

“…In our cohort, symptom recurrence was the most common indication for revision CTR (59% of revisions) followed by symptom persistence (40% of revisions). Although prior studies have reported symptom persistence as the most common indication, 5,6,8,11,15 they were based on smaller cohorts with shorter follow-up, supporting the call for longer-term studies. 22 We found that revision for recurrent symptoms occurred at a significantly longer median interval of 4.1 years, compared with 1.2 years for persistent symptoms, and our data indicate that reoperation for recurrence of symptoms was more common than previously recognized.…”

“…To our knowledge, we report the largest study on this topic to date, providing important information to help guide surgeons and patients in their selection of CTR technique. Although revision CTR is uncommon, delineating its incidence and risk factors is important for public health, considering that CTR is among the most common operations in the US and that outcomes of revision CTR are suboptimal . With recent studies reporting an increased risk of revision CTR following ECTR, precise characterization of this association is needed.…”

“…Although revision CTR is uncommon, delineating its incidence and risk factors is important for public health, considering that CTR is among the most common operations in the US 3 and that outcomes of revision CTR are suboptimal. 7 , 8 , 9 With recent studies reporting an increased risk of revision CTR following ECTR, 4 , 5 , 20 precise characterization of this association is needed.…”

“… 1 , 2 , 3 However, revision surgery has been estimated to occur in 1% to 5% of patients 2 , 4 , 5 for indications including failure to relieve the presenting symptoms, symptom recurrence following a symptom-free interval, or development of new symptoms. 6 Although outcomes data are lacking, revision CTR has been associated with unsatisfactory results, including persistence of symptoms and decreased patient-reported pain and satisfaction scores, 7 , 8 , 9 and there is accordingly interest in identifying factors leading to revision.…”

State of the art review. Complications after carpal tunnel release

“…If symptoms persist despite conservative treatment, reoperation may be indicated. Although improved symptoms are reported, outcomes after revision surgery are generally worse than primary surgery (Westenberg et al, 2023). Moreover, unlike primary CTR, revision surgery is much more complex due to scarring and unpredictable in terms of anatomical findings (Figure 5).…”