The wrapping technique aims to protect the nerve when the nerve bed is compromised or more commonly to prevent recurrence of scar tether following neurolysis. A wrap provides a physical barrier to scar and helps restore the paraneurial gliding layer. This study aims to evaluate the results of the AxoGuard® nerve protector, a porcine-derived submucosal extracellular matrix (PECM), when used as an adjunct in persistent or recurrent cubital tunnel syndrome (CuTS).This retrospective cohort study evaluated patients diagnosed between 2012 and 2020, with neuropathic pain, requiring revision surgery. Patients were categorised as Group A (revision surgery only) and Group B (revision surgery and adjunctive PECM nerve wrapping). Disease severity was scored at baseline and six months post-operatively using the McGowan classification. A linear regression model was performed to assess the effect of wrapping the ulnar nerve on the clinical outcome at six months.Fifty-nine nerves were treated and in 32 of those, adjunctive PECM wrapping was used. Disease severity at baseline was similar between groups. After adjusting for differences in baseline characteristics, participants in Group B improved with a significant difference of 0.43 McGowan points more than Group A (95%CI(0.01 – 0.86), p = 0,049). There were no implant related complications. Group B improved with an excellent/good outcome in 84.4% at final follow-up.Persistent or recurrent CuTS were associated with neuropathic pain and significant nerve scar tether. The use of PECM appears to lead to improved clinical symptoms, through a mechanism of action thought to reduce adhesions and encourage physiological glide.Level III evidence.