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Risk Factors for Revision After In-Situ Ulnar Nerve Decompression with or without Medial Epicondylectomy in Patients with Idiopathic Cubital Tunnel Syndrome
Michael P. Gaspar, MD; Patrick M. Kane, MD; Dechporn Putthiwara, MD; Sidney M. Jacoby, MD; A. Lee Osterman, MD
Thomas Jefferson University, Philadelphia Hand Center, Philadelphia, PA

Purpose: To compare revision rates after ulnar nerve in-situ decompression alone or with medial epicondylectomy (ME) for idiopathic cubital tunnel syndrome (CuTS) and identify patient risk factors for revision.

Methods: We conducted a retrospective chart review of all patients treated at one institution with an open in- situ ulnar nerve decompression with or without ME for idiopathic CuTS from 2001 through 2010. Revision rates were determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery and used to develop a binary logical regression model.

Results: Revision surgery was required in 4.4% (13 of 293) of all surgeries, with a significantly higher rate performed following in-situ ulnar nerve decompression with ME (15.5%) versus decompression alone (1.7%; p < 0.0001). Predictors of revision surgery included initial age of less than 50 years (Relative Risk = 4.72; see Figures 1-3) and an associated Workers' Compensation claim (RR 2.51).

Conclusions: For patients with idiopathic cubital tunnel syndrome, the risk of revision surgery was significantly greater following in-situ decompression with ME versus decompression alone. Patients younger than 50 years of age are at a higher risk for needing revision, as are patients with associated Workers' Compensation claims. Patient specific factors, including gender, medical and smoking history, symptom(s) and McGowan staging do not appear to have any significant impact on the likelihood of revision cubital tunnel surgery. Level of Evidence: Prognostic Level III
Figure 1: Age distribution of cases (patients requiring revision surgery) versus controls. Note the proportion of patients in both groups relative to the age of 50 years.

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