Revision Carpal Tunnel Release Following Endoscopic Compared With Open Decompression

Area of Science:

• Orthopedic surgery
• Hand surgery
• Surgical outcomes research

Background:

• Carpal tunnel release (CTR) techniques, including endoscopic CTR (ECTR) and open CTR (OCTR), may impact the need for subsequent revision surgery.
• Previous studies comparing revision CTR rates after ECTR versus OCTR have been limited by small sample sizes and short follow-up periods.

Purpose of the Study:

• To determine the incidence of revision CTR after ECTR compared to OCTR within a large national cohort.
• To analyze the indications and intraoperative findings associated with revision CTR based on the initial surgical technique.

Main Methods:

• A retrospective cohort study utilizing data from the US Veterans Health Administration.
• Included over 134,000 wrists from adult patients undergoing outpatient CTR between 1999 and 2021.
• Analyzed time to revision CTR, indications for revision, and intraoperative findings, comparing ECTR with OCTR.

Main Results:

• The cumulative incidence of revision CTR was 1.06% at 5 years and 1.59% at 10 years.
• ECTR was associated with a significantly higher hazard of revision compared to OCTR (aHR, 1.56; P < .001), with a 5-year number needed to harm of 176.
• Symptom recurrence was the most common reason for revision. Intraoperative findings differed, with transverse carpal ligament (TCL) reconstitution more frequent after ECTR, and scarring more common after OCTR.

Conclusions:

• While ECTR is linked to a higher risk of revision CTR than OCTR, the absolute risk of revision surgery is low irrespective of the technique used.
• Intraoperative findings during revision CTR vary significantly depending on whether the initial surgery was endoscopic or open.