Open and endoscopic carpal tunnel release may lead to similar rates of revision

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Key takeaways:

  • Results showed endoscopic carpal tunnel release had an increased risk of revision vs. open carpal tunnel release.
  • Researchers found the absolute difference between the revision rates was not significant.

Choosing either the endoscopic or open surgical technique for index carpal tunnel release may not meaningfully impact the risk of revision surgery, according to data published in JAMA Network Open.

“The absolute incidence of revision carpal tunnel release was low regardless of the index technique,” Ravi F. Sood, MD, MS, assistant professor of hand and microvascular surgery at UC Davis School of Medicine, told Healio. “Therefore, although there are many factors to consider when selecting the technique for carpal tunnel release, the potential need for revision surgery is likely not a reason to choose one over the other.”

Image of arthritic hand

Endoscopic carpal tunnel release had an increased risk of revision vs. open carpal tunnel release. Image: Adobe Stock

To determine whether surgical technique at the time of an index carpal tunnel release procedure impacted the risk of revision surgery, Sood and colleagues retrospectively analyzed data from the U.S. Veterans Health Administration on 134,851 open or endoscopic carpal tunnel release procedures performed on 103,455 patients (89.4% men; median age, 62 years).

Ravi F. Sood

Ravi F. Sood

Overall, researchers found the rate of revision carpal tunnel release was 2.3% following endoscopic carpal tunnel release vs. 1.5% following open carpal tunnel release at 10-year follow-up. However, Sood told Healio the absolute difference between revision rates in the two groups was “smaller than expected.”

In addition, in analyzing 1,809 revision cases, researchers found recurrence of symptoms after a symptom-free interval was the most common indication for reoperation. Scarring of the overlying soft tissues and the median nerve — associated with higher rates of neurolysis and flap procedures — was more likely to be found during revision after open carpal tunnel release, while a reconstituted or incompletely released transverse carpal ligament was more likely to be found in revision after endoscopic release, according to Sood. “In cases of incomplete transverse carpal ligament release, the distal portion was more commonly found to be intact regardless of index technique, whereas a commonly held belief is that incomplete distal release is more common during endoscopic release and incomplete proximal release is more common during open release,” Sood said.

He concluded, “Further research on outcomes of revision surgery following endoscopic compared to open decompression would be helpful, as well as prospective studies of intra-operative findings during revision surgery.”

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