Abstract
ObjectiveTo pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.MethodsA comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.ResultsThree studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was ‘low’ or ‘moderate’ on the basis of GRADE approach.ConclusionsBased on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore, more high-quality randomized controlled trials with standardized clinical improvement metrics are required to further clarify this topic and to provide reproducible pre- and postoperative objective outcomes.
Highlights
Cubital tunnel syndrome, called ulnar neuropathy at the elbow, is referred as the second most common entrapment neuropathy of the peripheral nerves after carpal tunnel syndrome [1, 2]
Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% confidence intervals (CI) 0.86 to 1.25, P = 0.72)
The results of the present study suggest that anterior subcutaneous and submuscular transposition might be effective in patients with ulnar neuropathy at the elbow
Summary
Called ulnar neuropathy at the elbow, is referred as the second most common entrapment neuropathy of the peripheral nerves after carpal tunnel syndrome [1, 2] It predominantly affects the region innervated by ulnar nerve, which is characterized by pain, paraesthesias or anaesthesia, and weakness or atrophy of ulnar nerve innervated muscles. Transpositional surgical treatments of cubital tunnel syndrome, including subcutaneous, intramuscular and submuscular [4], remain controversial, which comes from the diverging results for each of the therapeutic modality Those who prefer anterior subcutaneous transposition claim that it produces less postoperative pain with earlier mobilization and the reduction of tension on the nerve [5, 6]. Submuscular transposition, based on the histological study using the rat model, displayed less perineural scar tissue and healthier axons when compared to subcutaneous transposition [10]
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