title: Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.
  
  
  METHODS
  A comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.
  
  
  RESULTS
  Three studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was 'low' or 'moderate' on the basis of GRADE approach.
  
  
  CONCLUSIONS
  Based on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore, more high-quality randomized controlled trials with standardized clinical improvement metrics are required to further clarify this topic and to provide reproducible pre- and postoperative objective outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Chang-Xian
authors.initials: CX
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Shengli Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Han-Long
authors.initials: HL
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Xiao-Bin
authors.initials: XB
authors.lastname: Ke
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Zhuang
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Zhan-Long
authors.initials: ZL
authors.lastname: Lai
authors.affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Wu
authors.affiliation: Department of Orthopaedic Surgery, Fuzhou Second Hospital of Xiamen University, Xiamen, Fujian Province, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Lin
mesh_terms: D020430:Cubital Tunnel Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D014459:Ulnar Nerve / Q000601:surgery