Endoscopic versus open carpal tunnel release, which has low incidence of revision CTR?

The cohort study of 134 851 wrists from 103 455 patients undergoing CTR in the Veterans Health Administration (VHA) revealed an association between endoscopic CTR and a significantly higher hazard of revision. However, the incidence of revision was low irrespective of index CTR technique, with a risk difference of 0.72% at 10 years for endoscopic CTR. The study was published in JAMA Network Open on January 12, 2024. 

The carpal tunnel release technique may impact the likelihood of revision surgery. Prior studies of revision CTR following endoscopic CTR (ECTR) compared with open CTR (OCTR) have been limited by duration of follow-up and sample size. Peter C. Ferrin, Department of Surgery, Oregon Health & Science University, Portland, and colleagues aimed to estimate the incidence of revision CTR following ECTR compared with OCTR in a national cohort.

The retrospective cohort study used data from the US Veterans Health Administration. Participants included were all adults undergoing at least 1 outpatient CTR from 1999 to 2021. Data analysis was done from May 21, 2021, to November 27, 2023.

The study's primary outcome was the time to revision CTR. Secondary outcomes included findings during revision, indications for revision, and additional procedures performed during revision.

Based on the study, the researchers reported the following findings:

• Among 134 851 wrists from 103 455 patients (89.4% male; median age, 62 years) undergoing at least 1 CTR, 1809 wrists underwent at least 1 revision at a median of 2.5 years.
• In competing-risks analysis, the cumulative incidence of revision was 1.06% at 5 years and 1.59% at 10 years.
• ECTR was associated with an increased hazard of revision CTR compared with OCTR (adjusted hazard ratio [aHR], 1.56).
• The risk difference for revision CTR associated with ECTR compared with OCTR was 0.57% at 5 years (number needed to harm, 176) and 0.72% at 10 years (number needed to harm, 139).
• Regardless of the index CTR technique, the most common indication for revision was symptom recurrence (58.7% wrists).
• A reconstituted transverse carpal ligament (TCL) was more common after ECTR compared with OCTR, whereas scarring of the overlying tissues and of the median nerve itself was more common following OCTR.
• The incomplete transverse-carpal-ligament release was observed in 251 of the wrists undergoing revision CTR (13.94%) and was more common among revisions following ECTR (odds ratio, 1.62).

In the cohort study of revision CTR in the VHA, ECTR was associated with an increased risk of revision compared with OCTR, but regardless of technique, the absolute risk was low. There was a significant variation in intraoperative findings at revision according to the index CTR technique.

Reference:

Ferrin PC, Sather BK, Krakauer K, Schweitzer TP, Lipira AB, Sood RF. Revision Carpal Tunnel Release Following Endoscopic Compared With Open Decompression. JAMA Netw Open. 2024;7(1):e2352660. doi:10.1001/jamanetworkopen.2023.52660

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