Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release
Purpose: This study aimed to evaluate the safety and effectiveness of mini-open carpal tunnel release (mOCTR) using best-evidence synthesis methods. Methods: We systematically searched for prospective studies published from January 2013 to July 2023 that reported outcomes from a minimum of 50 mOCTR...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Journal of Hand Surgery Global Online |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589514123001469 |
| _version_ | 1797350566569967616 |
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| author | Warren C. Hammert, DDS, MD Kevin C. Chung, MD, MS Larry E. Miller, PhD, PStat |
| author_facet | Warren C. Hammert, DDS, MD Kevin C. Chung, MD, MS Larry E. Miller, PhD, PStat |
| author_sort | Warren C. Hammert, DDS, MD |
| collection | DOAJ |
| description | Purpose: This study aimed to evaluate the safety and effectiveness of mini-open carpal tunnel release (mOCTR) using best-evidence synthesis methods. Methods: We systematically searched for prospective studies published from January 2013 to July 2023 that reported outcomes from a minimum of 50 mOCTR cases. The outcomes included Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), pain visual analog scale (VAS), complication rate, and reoperation rate. Data analysis was performed using a random-effects meta-analysis, with metaregression to identify the associations between patient- and study-level factors with surgical outcomes. Results: The meta-analysis included 23 studies with 2,303 patients followed for median durations ranging from 6 to 12 months depending on the outcome. Mini-open carpal tunnel release resulted in statistically significant and clinically important improvements in Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (mean difference = −25.5; 95% confidence interval [CI]: −36.4 to −14.5; P < .001), BCTQ-SSS (mean difference = −2.2; 95% CI: −2.5 to −1.9; P < .001), BCTQ-FSS (mean difference = −2.1; 95% CI: −2.4 to −1.7; P < .001), and pain VAS (mean difference = −5.1; 95% CI: −6.2 to −4.1; P < .001). The sole predictor of improvement in BCTQ-SSS, BCTQ-FSS, and pain VAS was a higher preoperative score for the respective variable (all P < .001). The risk of complications (mainly short-term pillar pain or scar complications) was 8.9% (95% CI: 4.0%–13.8%) and increased with longer incision lengths (P = .008). Revision carpal tunnel release was performed in 0.6% (95% CI: 0.1%–1.0%) of the cases during follow-up. No cases of median nerve transection were reported. Conclusions: Based on a best-evidence meta-analysis of contemporary studies, mOCTR significantly improved function and pain, with a relatively low risk of mainly temporary complications. Patient outcomes after mOCTR were influenced by patient symptomatology and surgical incision length. Clinical relevance: Mini-open carpal tunnel release is an effective surgical option that significantly improves symptoms and function, especially for patients with more severe baseline dysfunction. Surgeons should use the shortest incision that allows adequate visualization to safely divide the transverse carpal ligament. |
| first_indexed | 2024-03-08T12:47:47Z |
| format | Article |
| id | doaj.art-daf6485450b14876a08e48f60db138ad |
| institution | Directory Open Access Journal |
| issn | 2589-5141 |
| language | English |
| last_indexed | 2024-03-08T12:47:47Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj.art-daf6485450b14876a08e48f60db138ad2024-01-21T05:10:02ZengElsevierJournal of Hand Surgery Global Online2589-51412024-01-01613542Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel ReleaseWarren C. Hammert, DDS, MD0Kevin C. Chung, MD, MS1Larry E. Miller, PhD, PStat2Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University Medical Center, Durham, NCUniversity of Michigan Comprehensive Hand Center, Michigan Medicine, Ann Arbor, MIMiller Scientific, Johnson City, TN; Corresponding author: Larry E. Miller, PhD, PStat, Miller Scientific, 3101 Browns Mill Road, Ste 6, #311, Johnson City, TN 37604.Purpose: This study aimed to evaluate the safety and effectiveness of mini-open carpal tunnel release (mOCTR) using best-evidence synthesis methods. Methods: We systematically searched for prospective studies published from January 2013 to July 2023 that reported outcomes from a minimum of 50 mOCTR cases. The outcomes included Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), pain visual analog scale (VAS), complication rate, and reoperation rate. Data analysis was performed using a random-effects meta-analysis, with metaregression to identify the associations between patient- and study-level factors with surgical outcomes. Results: The meta-analysis included 23 studies with 2,303 patients followed for median durations ranging from 6 to 12 months depending on the outcome. Mini-open carpal tunnel release resulted in statistically significant and clinically important improvements in Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (mean difference = −25.5; 95% confidence interval [CI]: −36.4 to −14.5; P < .001), BCTQ-SSS (mean difference = −2.2; 95% CI: −2.5 to −1.9; P < .001), BCTQ-FSS (mean difference = −2.1; 95% CI: −2.4 to −1.7; P < .001), and pain VAS (mean difference = −5.1; 95% CI: −6.2 to −4.1; P < .001). The sole predictor of improvement in BCTQ-SSS, BCTQ-FSS, and pain VAS was a higher preoperative score for the respective variable (all P < .001). The risk of complications (mainly short-term pillar pain or scar complications) was 8.9% (95% CI: 4.0%–13.8%) and increased with longer incision lengths (P = .008). Revision carpal tunnel release was performed in 0.6% (95% CI: 0.1%–1.0%) of the cases during follow-up. No cases of median nerve transection were reported. Conclusions: Based on a best-evidence meta-analysis of contemporary studies, mOCTR significantly improved function and pain, with a relatively low risk of mainly temporary complications. Patient outcomes after mOCTR were influenced by patient symptomatology and surgical incision length. Clinical relevance: Mini-open carpal tunnel release is an effective surgical option that significantly improves symptoms and function, especially for patients with more severe baseline dysfunction. Surgeons should use the shortest incision that allows adequate visualization to safely divide the transverse carpal ligament.http://www.sciencedirect.com/science/article/pii/S2589514123001469Best evidenceCarpal tunnel releaseCarpal tunnel syndromeMeta-analysisMini-openSystematic review |
| spellingShingle | Warren C. Hammert, DDS, MD Kevin C. Chung, MD, MS Larry E. Miller, PhD, PStat Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release Journal of Hand Surgery Global Online Best evidence Carpal tunnel release Carpal tunnel syndrome Meta-analysis Mini-open Systematic review |
| title | Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release |
| title_full | Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release |
| title_fullStr | Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release |
| title_full_unstemmed | Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release |
| title_short | Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release |
| title_sort | best evidence systematic review and meta analysis of mini open carpal tunnel release |
| topic | Best evidence Carpal tunnel release Carpal tunnel syndrome Meta-analysis Mini-open Systematic review |
| url | http://www.sciencedirect.com/science/article/pii/S2589514123001469 |
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