Endoscopic versus Open Carpal Tunnel Release: A Systematic Review and Meta-analysis

Carpal tunnel syndrome accounts for the most prevalent type of peripheral neuropathy encountered by surgeons in clinics worldwide. Despite several studies investigating endoscopic carpal tunnel release (ECTR) in comparison to open carpal tunnel release (OCTR), the best option is yet to be identified. In this systematic review and meta-analysis, we sought to evaluate and compare the surgery outcomes and complications associated with ECTR and OCTR by analyzing evidence from randomized controlled trials (RCTs) to determine if one technique offers superior results compared with the other. In this study, the systematic search was performed using MEDLINE and Embase search engines (via OVID SP), Scopus, Web of Science, and Cochrane Library until April 2024. We hand-searched references of the included studies as well. All RCTs that compared ECTR and OCTR approaches were included. Data on key clinical outcomes and complications, including return to work, revision surgery, nerve injury, operation time, and overall complications, were extracted and analyzed. A meta-analysis was performed if at least three studies reported the prognostic factor. The random-effect models were used. Thirty-three RCTs were included in our study, comprising 1,568 OCTR and 1,447 ECTR. ECTR was associated with shorter time to return to work in comparison with OCTR (mean difference [MD]: -8.08 days; 95% confidence interval [CI]: -12.71 to -3.46). Furthermore, ECTR had lower scar-related complication rates compared with OCTR (odds ratio [OR]: 0.18; 95% CI: 0.08 to 0.37). The meta-analysis showed no significant differences between ECTR and OCTR in revision surgery (OR, 0.78; 95% CI: 0.34 to 1.78), permanent nerve injury (OR: 1.62; 95% CI: 0.08 to 31.81), transient nerve injury (OR: 2.29; 95% CI: 0.73 to 7.20), operation time (MD, -3.22; 95% CI: -9.53 to 3.08), and overall complications (OR: 0.88; 95% CI: 0.49 to 1.61). Based on randomized evidence, ECTR was associated with a shorter time to return to work and fewer scar-related complications compared with OCTR. The assessment of revision surgery, permanent nerve injury, transient nerve injury, operation time, and overall complications showed no significant advantage for any of the techniques.