title: Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials.
abstract: The objective of this study is to do a meta-analysis of the literature and compare the safety and efficacy of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) for idiopathic carpal tunnel syndrome (CTS). A comprehensive literature search of the electronic databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register was undertaken for randomized studies reporting carpal tunnel syndrome treated with ECTR or OCTR. The quality of randomized trials was critically assessed. Pooled relative risk (RR) and 95% confidence intervals (CIs) for safety and efficacy outcome variables were calculated by fixed-effect or random-effect methods with RevMan v.5.1 provided by the Cochrane Collaboration. A total of 13 randomized trials were included by total retrieve and riddling. The results of our meta-analysis showed no significant difference in the overall complication rate (RR = 1.34, 95% CI [0.74, 2.43], P = 0.34), subjective satisfaction (RR = 1.0, 95% CI [0.93, 1.08], P = 0.92), time to return to work (mean difference = -3.52 [-8.15, 1.10], P = 0.14), hand grip and pinch strength, and the operative time (mean difference = -1.89, 95% CI [-5.84, 2.06]) between patients in the ECTR and OCTR groups (P = 0.16, 0.70, and 0.35, respectively). The rate of hand pain (RR = 0.73, 95% CI [0.53, 0.93], P = 0.02) in the ECTR group was significantly lower than that in the OCTR group. ECTR treatment seemed to cause more reversible postoperative nerve injuries as compared with OCTR (RR = 2.38, 95% CI [0.98, 5.77], P = 0.05). Although ECTR significantly reduced postoperative hand pain, it increased the possibility of reversible postoperative nerve injury in patients with idiopathic CTS. No statistical difference in the overall complication rate, subjective satisfaction, the time to return to work, postoperative grip and pinch strength, and operative time was observed between the two groups of patients.
authors: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072, Shanghai, China. zuozuo198@163.com.
authors: Dongqing
authors: D
authors: Zuo
authors: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072, Shanghai, China. smx_sy@126.com.
authors: Zifei
authors: Z
authors: Zhou
authors: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072, Shanghai, China. wanghs1231@gmail.com.
authors: Hongsheng
authors: H
authors: Wang
authors: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072, Shanghai, China. sunmengxiong@126.com.
authors: Yuxin
authors: Y
authors: Liao
authors: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072, Shanghai, China. Longpozheng@163.com.
authors: Longpo
authors: L
authors: Zheng
authors: Department of Orthopaedics, Affiliated People's First Hospital, Shanghai Jiaotong University, 200080, Shanghai, China. zuozuo204@163.com.
authors: Yingqi
authors: Y
authors: Hua
authors: Department of Orthopaedics, Affiliated People's First Hospital, Shanghai Jiaotong University, 200080, Shanghai, China. zhdcai@gmail.com.
authors: Zhengdong
authors: Z
authors: Cai
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D004724:Endoscopy / Q000706:statistics & numerical data; D018737:Hand Strength; D006801:Humans; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D062707:Return to Work
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