Research Article: 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

Date Published: January 28, 2019

Publisher: Public Library of Science

Author(s): Sike Lai, Kaibo Zhang, Jian Li, Weili Fu, Leila Harhaus.


Carpal 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.

The 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).

A 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).

Carpal 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.

Partial Text

Carpal tunnel syndrome (CTS) is the most commonly diagnosed compression neuropathy in the upper extremities, which may lead to mild to moderate disability without appropriate treatment[1–3]. The incidence rates reported range from 0.3 to 3.3 per 1000 person per year[4]. Being prevalent in the Medicare patient population, CTS is associated with a large amount of economic burden[5]. The pathophysiology of CTS is complex and results from interactions of many mechanisms. The pathophysiologic mechanism of CTS is likely attributable to abnormally high carpal tunnel pressure and traction neuropathy[6]. Carpal tunnel release (CTR), also described as release of the flexor retinaculum (FR), is the most common surgical technique for CTS. However, complications such as nerve dysfunction, pillar pain and loss of grip strength after CTR have drawn adequate attention. Several modifications of CTR have been introduced to increase the efficacy as well as ensure the safety of treatment, one of which is the flexor retinaculum reconstruction (FRR)[7–11]. However, previous studies comparing effects of CTR with and without FRR show that significant differences do exist, albeit findings are somewhat contradictory[10, 12–15]. Therefore, we set out to perform meta-analysis of the evidence from randomized controlled trials. This study assumed that no difference would be found in grip strength and clinical outcomes between patients undergoing CTR with or without FRR.

Of the 7 studies, 3 studies[21, 22, 25], including 134 patients treated with FRR and 158 with control, reported short-term outcomes of SSS. As shown in Fig 5, there’s no statistically significant difference between the groups (MD-0.03, 95% CI -0.16 to 0.10, P = .64, I2 = 0%).

This meta-analysis did not find a significant difference of short- and long-term outcomes between carpal release with and without FRR regarding symptoms relief and post-operative complications despite a functional benefit of FRR over CTR in short-term grip strength and long-term FSS improvement.




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