Evaluation of Different Surgical Techniques for Revision Cubital Tunnel Release: A Meta-Analysis of Patient-Reported Symptoms

Ramin Shekouhi; Justin Taylor; Xizhao Chen; Annika Liu; Kevin A Hao; Ariel Pomputius; Harvey Chim

doi:10.1016/j.jhsa.2023.11.012

Evaluation of Different Surgical Techniques for Revision Cubital Tunnel Release: A Meta-Analysis of Patient-Reported Symptoms

J Hand Surg Am. 2024 Feb;49(2):124-140. doi: 10.1016/j.jhsa.2023.11.012. Epub 2023 Dec 15.

Authors

Ramin Shekouhi¹, Justin Taylor², Xizhao Chen³, Annika Liu⁴, Kevin A Hao⁴, Ariel Pomputius⁵, Harvey Chim⁶

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL.
² College of Medicine, University of Central Florida, Orlando, FL.
³ Department of Surgery, University of Florida, Gainesville, FL.
⁴ College of Medicine, University of Florida, Gainesville, FL.
⁵ University of Florida Health Science Center Libraries, Gainesville, FL.
⁶ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL. Electronic address: harveychim@yahoo.com.

PMID: 38108682
DOI: 10.1016/j.jhsa.2023.11.012

Abstract

Purpose: Controversy exists regarding the best option for revision surgery in refractory cubital tunnel syndrome (CuTS). The purpose of this systematic review was to evaluate the effectiveness of revision surgery and determine the optimal surgical approach for patients requiring revision surgery for CuTS.

Methods: A literature search was conducted. Characteristics of the included studies were summarized descriptively. The risk ratio between patient-reported preoperative and postoperative outcomes relating to pain, motor, and sensory deficits was calculated. A meta-regression analysis was performed to evaluate the postoperative symptom improvements based on the type of secondary surgery. Random-effects meta-analysis and descriptive statistics were used when appropriate.

Results: A total of 471 patients were evaluated in 20 studies. In total, 254 (53.9%) male and 217 (46.1%) female patients, with an average age of 49.2 ± 14.1 years, were included in this study. Pain was the most common symptom (n = 346, 81.6%), followed by sensory and motor dysfunction in 342 (80.6%) and 223 (52.6%) patients, respectively. Meta-analysis comparing preoperative and postoperative symptoms between patients who had submuscular transposition (SMT), subcutaneous transposition (SCT), and neurolysis showed that a significant subgroup difference exists between the types of revision surgery in sensory and motor improvements. Meta-regression showed that SMT was associated with better outcomes compared with SCT in motor and sensory improvements.

Conclusions: Revision surgery for CuTS can be useful for addressing recurrent and persistent symptoms. Compared with neurolysis and SCT, SMT seems to be the superior option for revision surgery, demonstrating substantial improvement in all symptom domains.

Type of study/level of evidence: Therapeutic IV.

Keywords: Compressive neuropathy; cubital tunnel; subcutaneous transposition; submuscular transposition; ulnar nerve.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Adult
Cubital Tunnel Syndrome* / diagnosis
Cubital Tunnel Syndrome* / surgery
Decompression, Surgical / methods
Female
Humans
Male
Middle Aged
Neurosurgical Procedures / methods
Pain
Patient Reported Outcome Measures
Retrospective Studies
Ulnar Nerve* / surgery