The Maturing of a Surgical Approach — Endoscopic CTR

The latest meta-analysis on endoscopic vs. open carpal tunnel surgery gives us what we need to know

What’s the Claim?

A meta-analysis of randomized clinical trials found:

  • Endoscopic carpal tunnel release (CTR) resulted in lower odds of scar pain persisting 6 weeks after surgery compared to open CTR (odds ratio 2 [95% CI 1.2 to 3.4]), a finding that was driven by dual-tunnel endoscopic CTR, as single-portal endoscopic CTR did not differ from open CTR in terms of the presence of scar pain at 6 weeks.
  • Endoscopic approaches resulted in faster return to work by a mean of 7 days (95% CI 5 to 10 days), but open approaches were associated with a lower odds of transient nerve injuries than endoscopic approaches (OR = 0.2 [0.08, 0.6]), with no differences between single- and dual-portal techniques on any of those endpoints.
  • No differences in the odds of complications, overall reoperations, or reoperations for symptom recurrence or incomplete release of the transverse carpal ligament between open and endoscopic techniques, or between the single- and dual-portal endoscopic approaches. Likewise there were no between-group differences in satisfaction, symptom relief, or outcomes scores (Boston Carpal Tunnel Questionnaire).

How’s It Stack Up?