Endoscopic Versus Open Carpal Tunnel Release: An Umbrella Review and a Meta-analysis

Wednesday, February 21, 2024

Presenting Author(s)

Hani Chanbour, MD

Spine fellow
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
Nashville, TN, US

Co-Author(s)

DE

Diala El Masri, BS

Medical student
Balamand University, United States
MG

Maya Ghazi, N/A

Medical student
Lebanese University, United States
JH

J. Bradford Hill, Md

Plastic surgeon
Vanderbilt University Medical Center, United States
David Liles, MD

Resident
Vanderbilt University Medical Center
Nashville, TN, US
JM

Jad Masri, MS

medical
Lebanese University, United States
PS

Pascale Salemeh, PharmD, MPH, PhD, HDR

Professor
Lebanese University, United States
Scott L. Zuckerman, MD, MPH (he/him/his)

Assistant Professor of Neurological Surgery
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure(s):

Hani Chanbour, MD: No financial relationships to disclose

David Liles, MD: No financial relationships to disclose

Introduction: Whether endoscopic carpal tunnel release (ECTR) vs. open carpal tunnel release (OCTR) has superior outcomes remains a controversial topic. Therefore, we sought to perform an umbrella review and meta-analysis to compare ECTR and OCTR with regards to: 1) postoperative functional ability, 2) operative outcomes, and 3) time to return to work.

Methods: A PubMed, Scopus and Cochrane database search was conducted for all meta-analyses comparing ECTR and OCTR performed between 2000-2022 in accordance to PRISMA and Joanna Briggs Institute guidance for umbrella reviews. The primary outcomes were: 1) functional ability: symptoms severity, postoperative grip strength, postoperative pinch strength, two-point discrimination and pain, 2) operative outcomes: operation time, total complications, nerve injury, scar formation, and 3) time to return to work. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). Pooled analysis was performed to compare several clinical outcome measures between groups, depending on the availability of data using Review Manager Version 5.2.11.

Results: A total of 9 meta-analyses were included, 5 were of high quality and 4 were moderate quality. Functional ability: ECTR was associated with better pinch strength after 3 months (0.70, 95%CI=0.00, 1.40, p=0.05) and 6 months (0.77, 95%CI=0.14, 1.40, p=0.02, I²=84%). Operative outcomes: OCTR was associated with more risk of scar formation (0.40, 95%CI=0.24, 0.66, p=0.0003, I²=41). Return to work: OCTR was associated with longer return to work compared to ECTR (-10.89, 95%CI=-15.14, -6.64, p< 0.00001, I²=83%). There were no significant differences between OCTR and ECTR in the hand function, symptom severity, grip strength, pain, operation time and total complications.

Conclusion : In an umbrella review and meta-analysis of ECTR vs. OCTR, ECTR was associated with a higher pinch strength, less scar formation, and a shorter time to return to work. Differences in major complications, such as nerve injury, were unclear due to statistical inconsistency and bias.