2015 ISAKOS Biennial Congress ePoster #701
Endoscopic Release is at Least as Safe as Conventional Open for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis of Randomized Trials
Haris S. Vasiliadis, MD, PhD, Bern SWITZERLAND
Adriani Nikolakopoulou, MSc, Ioannina GREECE
Ian Shrier, PhD, Montreal CANADA
Rob Scholten, Prof., Utrecht NETHERLANDS
Georgia Salanti, PhD, Ioannina GREECE
University of Ioannina, Ioannina, GREECE
FDA Status Not Applicable
Summary: The level I evidence from the randomized trials suggests that Endoscopic Carpal Tunnel Release is associated with faster recovery and less minor complications compared with conventional open release. The major complication rate, the recurrence and reoperation rate are comparable with the OCTR.
ePoster Not Provided
An increased rate of complications has been attributed to the endoscopic release of the carpal tunnel (ECTR) for the treatment of carpal tunnel syndrome (CTS). The complication rate reported in the literature ranges from 2% to up to 35%, adding to the skepticism against the endoscopic treatment. Theoretically endoscopic release should be associated with less postoperative morbidity compared to open release (OCTR) because it is minimally invasive. The aim of our study was to summarize the available evidence from randomized control trials to assess the safety of ECTR compared with OCTR.
We systematically searched the literature and included all randomized or quasi-randomized controlled trials that compared any ECTR with OCTR. The risk of bias in the included trials was assessed by two independent authors. Safety was assessed by the incidence of major and minor complications, recurrences, re-operations and the total time needed to return to work or daily activities. We performed meta-analyses for each outcome to synthesize the study findings.
Twenty seven unique randomized control trials fulfilled the inclusion criteria and were selected.
Overall, study limitations were important with the majority of the evidence coming from studies at high or unclear risk of bias. The method of randomization was judged as appropriate in only seven studies. The allocation was adequately concealed in only three studies none was blinded.
The meta-analysis revealed no material differences in the recurrences between endoscopic and open release (summary odds ratio from XX studies 1.02; 95% CI 0.55 to 1.90). Eleven studies reported 28 reoperations out of 1596 operations in total; no differences in their incidence was found between ECTR and OCTR release (summary odds ratio 1.36; OR 0.61 to 3.00). From 25 studies reporting major complications as an outcome, only in 10 of them reported the incidence of major complications. Meta-analysis did not reveal any differences in their incidence (summary odds ratio 1.00; 95% CI 0.44 to 2.27). There were in total 2430 hands with minor complications reported in 19 studies. The meta-analysis revealed that ECTR resulted on average to a lower rate of minor complications when compared with OCTR (summary odds ratio 0.51; 95% CI 0.30, 0.85). The rate of total complications does not differ between OCTR and ECTR (summary rate ratio 0.71; 95% CI 0.29, 1.55). Although no great differences were found in complications, patients treated with ECTR returned to work on average 10 days earlier that those in the OCTR group (summary mean difference -9.58; 95% CI -12.74 to -6.43).
No differences were found between the two procedures in terms of recurrence, reoperation rate or major complications. Evidence suggests ECTR is associated with significantly less time spent out of work or daily activities and is associated with a lower incidence of minor complications.