The Canaletto®™ implant for reconstructing transverse carpal ligament in carpal tunnel surgery. Surgical technique and cohort prospective study about 400 Canaletto cases versus 400 cases with open carpal tunnel surgery.
The techniques used for carpal tunnel release are open surgery, endoscopy and retinaculum repair. Postoperative outcome, however, is often altered by pain, weakness, insufficient sensory or motor recovery and recurrences. We propose, since March 2001, a new surgical technique based on the reconstruction of the flexor retinaculum using the Canaletto®™ implant. The present study consists in a comparative prospective analysis of 400 patients with a Canaletto®™ implant versus 400 patients having undergone open surgery without Canaletto. The average follow-up was 31 months (1-72 months). The rate of carpal tunnel syndrome recovery (suppression of diurnal and nocturnal paraesthesia) was 97.25% in the Canaletto group and 96.11% in the group without Canaletto. The quality of healing was better in the Canaletto group, with a reduced rate of postoperative oedema. Strength recovery defined as a postoperative strength between 80 and 100% of preoperative strength, as assessed by Jamar, was obtained in 67% of patients in the Canaletto group vs. 33% in the group without Canaletto at 1 month of follow-up. There were still some early strength failures in 226 patients (56.5%) of the group without Canaletto and 31 patients (7.75%) of the Canaletto group. In the long term, patients of the Canaletto group displayed strength between 120 and 200% of preoperative strength. Sensory recovery measured by visual analogic scale in patients with preoperative loss of sensitivity was better in the Canaletto group with an average of 8.9/10 vs. 5.8/10 in the group without Canaletto. No recurrence of carpal tunnel was observed in the Canaletto group whereas four recurrences occurred in the group without Canaletto. Mean duration of sick leave decreased from 5 weeks in the group without Canaletto to 3 weeks in the Canaletto group. Such mechanical and biological properties made this implant becoming part of our surgical armamentum; we use it in about 25% of our surgical procedures for carpal tunnel syndromes. There is some limitations regarding the results of this study due to: (1) a potential selection bias between the two cohorts related to Canaletto indication, and (2) one of the authors is also the designer of the implant (the other one has no conflict of interest).
Avignon Hand Surgery Center, Capio Fontvert Clinic, Avignon Nord, Val-du-Soleil, Sorgues, France. renaud.duche@wanadoo.fr
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Duché
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Trabelsi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011446:Prospective Studies; D019736:Prostheses and Implants; D011474:Prosthesis Design