Long-Term Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance (CTR-US): A Multicenter Pragmatic Study
Demetrio J Aguila, III, MD, FACS1, Paul D Paterson, MD2, Matthew J Kirsch, MD3 and Brett J Kindle, MD4, (1)Total Pain Solutions, Papillion, NE, (2)Vero Beach Orthopaedics, Vero Beach, FL, (3)Olmsted Medical Center, Rochester, MN, (4)Andrews Institute for Orthopaedics and Sports Medicine, Gulf Breeze, FL
Previous studies have demonstrated the safety and effectiveness of CTR-US in specific patient populations. None have reported the long-term clinical results of over 100 patients treated by multiple physicians in a real-world setting.
Materials & Methods
All patients participating in a post-market registry study of CTR-US outcomes who provided both pre-operative and one year post-operative data were included. All procedures were performed using a commercially available device (UltraGuideCTRTM) and primary outcomes were QDASH, BCTQ-SSS, and BCTQ-FSS at one year.
A total of 300 patients (341 hands) were treated by 25 different physicians, including 41 (13.7%) patients treated with simultaneous bilateral procedures. Mean patient age was 54.2 years, 63% were female, 24% had >2 comorbidities (anxiety and depression most common), and 54% had symptoms >2 years.
Mean QDASH decreased from 40.6±20.6 pre-operatively to 21.0±16.7 at 2 weeks and 12.2±18.3 at one year (Figure 1), mean BCTQ-SSS decreased from 3.0±0.7 pre-operatively to 1.7±0.6 at 2 weeks and 1.5±0.7 at one year, and mean BCTQ-FSS decreased from 2.4±0.8 pre-operatively to 1.7±0.6 at 2 weeks and 1.4±0.6 one year (Figure 2). All post-operative scores were significantly reduced compared to baseline at all time points (P<.001) and exceeded minimally clinically important differences at one year.
Patient subgroups were analyzed to investigate impact of baseline characteristics on one year outcomes (Table 1). Female patients improved more than male patients at one year (P<.008 for QDASH, BCTQ-SSS and BCTQ-FSS). Patients treated with simultaneous bilateral procedures had similar one year outcomes to those treated with unilateral procedures. Multiple other factors including high BMI, diabetes status, current tobacco use, rheumatoid/inflammatory arthritis, operation in the dominant hand, higher comorbidity burden, and concurrent ipsilateral procedures did not significantly affect one year outcomes.
In this multicenter pragmatic study, CTR-US resulted in rapid improvements in symptoms and function that were maintained through one year. Outcomes were consistent across a diverse patient population, including patients treated with simultaneous bilateral releases.
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