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

Abstract

INTRODUCTION: Whether open carpal tunnel release (OCTR) versus endoscopic carpal tunnel release (ECTR) has super outcomes remains a controversial topic. METHODS: A PubMed, Scopus and Cochrane databases was conducted for all meta-analyses comparing OCTR and ECTR performed between 2000-2022 in accordance to PRISMA and Joanna Briggs Institute guidance of umbrella reviews. The primary outcomes were: 1) functional ability: symptoms severity, grip strength, 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. Pooled analysis was performed to compare outcomes using Review Manager Version 5.2.11. RESULTS: 9 meta-analyses were included, 5 were of high quality and 4 were moderate quality on the Assessment of Multiple Systematic Reviews (AMSTAR) scale. Functional ability: OCTR was associated with better pinch strength after 3-months (0.70, 95% CI = 0.00, 1.40, p = 0.05) and after 6-months (0.77, 95% CI = 0.14, 1.40, p = 0.02, I2 = 84%). Operative outcomes: OCTR was associated with less nerve injury (3.26, 95% CI = 1.20, 8.86, p = 0.02, I2 = 0%) and more risk of scars 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 (-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. CONCLUSIONS: In an umbrella review and meta-analysis of OCTR vs. ECTR, we found that while OCTR demonstrated higher pinch strength and lower nerve injury risk, ECTR was associated with less scar formation and a shorter time to return to work.