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Simple vs. Endoscopic Cubital Tunnel Release: a Systematic Review
Salah Aldekhayel, MD, MEd; Alexander Govshievich; James Lee; Youssef Tahiri; Mario Luc
McGill University, Montreal, Canada

Introduction: Several techniques have been described for surgical treatment of cubital tunnel syndrome with no clear consensus. Among them, endoscopic release has recently been reported as a promising technique. This systematic review aims to compare outcomes and complications of open simple decompression and endoscopic decompression of the ulnar nerve in treatment of cubital tunnel syndrome.
Methods: The electronic databases PubMed MEDLINE, Ovid MEDLINE, EMBASE and SCOPUS were searched over period between 1975 and 2013. The following keywords were used: "cubital tunnel", "ulnar neuropathy", ulnar neuritis", "ulnar nerve entrapment", "open decompression", "in situ decompression", "endoscopic decompression", "arthroscopic decompression". Studies including adults with idiopathic cubital tunnel syndrome that were treated by either open simple or endoscopic release were included. Outcomes of interest included postoperative grade, complications, number of re-operations and the need for intra-operative conversion to another technique.
Results: A total of 118 studies were searched with 18 studies meeting the inclusion criteria. Four hundreds and seventy one open simple releases were described in 9 studies and 413 endoscopic releases were reported in the other 9 studies. All studies were observational. Six studies in each group were level II of evidence, remaining studies were level IV. In the open group, 84.1% experienced "good" or "excellent" results. The overall complication rate was 4.2% including hematoma (1 case), medial antebrachial cutaneous (MABC) nerve injury (14 cases), sensitive scar (4 cases), and infection (1 case). Re-operation rate was 2.3% due to persistent symptoms. In the endoscopic group, 85.9% experienced "good" or "excellent" results. The overall complication rate was 6.5% including hematoma (16 cases), numbness (4 cases), MABC nerve injury (1 case), ulnar nerve subluxation (5 cases), and infection (1 case). Re-operation rate was 2.4% for persistent symptoms (4 cases), hematoma (3 cases), nerve subluxation (2 cases), and infection (1 case). Two cases required conversion to open decompression due to ganglion surrounding the nerve and nerve subluxation. Comparisons of objective outcome measures were not possible due to heterogeneity of scales used.
Conclusions: Open simple decompression and endoscopic decompression are comparable in terms of outcomes and re-operation rate. Despite higher incidence of hematoma in endoscopic group that was mostly managed conservatively, endoscopic is shown to have less scar sensitivity and MABC nerve injury than open simple surgical release.


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