Time to recovery following open and endoscopic carpal tunnel decompression: meta-analysis

TL;DR

This study compares recovery after two types of carpal tunnel surgery, finding that endoscopic surgery may lead to fewer symptoms in the first two weeks, but open surgery might offer better long-term improvement.

Contribution

The study provides detailed recovery trajectories for carpal tunnel surgery and highlights the need for high-frequency outcome tracking in future trials.

Findings

Endoscopic CTR showed improved symptoms at 1 week compared to open CTR.

Open CTR demonstrated greater symptomatic improvement by week 3 and beyond.

Symptoms continued to improve up to 104 weeks after surgery for both approaches.

Abstract

Carpal tunnel release (CTR) can be performed using either an open or endoscopic approach. The patient recovery trajectories remain poorly understood. This study aimed to define and compare patient-reported recovery following unilateral open and endoscopic CTR.

A PRISMA-compliant, preregistered (CRD42023427718) systematic review was conducted, searching PubMed, Embase, and Cochrane databases on 4 July 2023 and 21 August 2024. Studies were included if they reported recovery data (patient-reported outcome measures (PROMs)) at predefined time points for adults undergoing unilateral CTR. Boston Carpal Tunnel Questionnaire and Quick Disabilities of Arm, Shoulder, and Hand scores were extracted. Standardized mean change (SMC) scores from baseline were pooled using random-effects meta-analysis. An innovative modification of the National Institutes of Health quality assessment tools was used to evaluate the risk of bias.

In all, 49 studies were included (4546 participants included in the analysis; 3137 open CTR, 1409 endoscopic CTR). Both approaches improved PROM scores over 12 weeks, with early (4-week) outcomes strongly correlating (>0.89) with later (12-week) outcomes. Symptoms continued improving up to 104 weeks. At 1 week, open CTR showed symptomatic deterioration (SMC 10.29; 95% confidence interval (c.i.) 6.35 and 14.21 respectively), comparatively, endoscopic CTR demonstrated an improvement (SMC −2.83; 95% c.i. −7.80 and 2.14 respectively). By 2 weeks, symptom severity remained slightly worse in open CTR, but confidence intervals overlapped from week 3 and thereafter open CTR showed greater symptomatic improvement. Most studies had a high risk of bias and measured outcomes too infrequently for a granular comparison.

Patient-reported recovery trajectories for CTR can inform patient counselling and future research. Endoscopic CTR may result in fewer symptoms in the first 2 weeks, but open CTR may offer comparable or potentially greater improvement thereafter. Future trials with high-frequency PROM capture should prioritize early (first 3 weeks) and long-term (≥24 weeks) outcomes.

Recovery trajectories following carpal tunnel release (CTR) remains poorly understood. This study aimed to define and compare patient-reported recovery trajectories after unilateral open and endoscopic CTR. Current evidence suggests that over the first 2 weeks endoscopic CTR may result in less severe postoperative symptoms than open CTR, but greater improvements in symptoms may be seen in open CTR thereafter. Future trials with high-frequency PROM capture should focus on the first 3 weeks after surgery as well as long-term outcomes.

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