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Comparative effectiveness of open versus percutaneous release with ultrasound-guided or non-ultrasound guided for trigger digits: A meta-analysis of Randomized controlled trials
Huang Kuan Chen, MD
1; Che-Hsiung Lee, MD
21Chang Gung memorial hospital, Taoyuan City, Taiwan, Taiwan; 2Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
IntroductionGiven the inconsistent and sometimes contradictory outcomes observed so far, it remains uncertain whether percutaneous or open surgical A1 pulley release is superior in terms of safety and effectiveness. This meta-analysis aims to compare and evaluate the efficacy of these two techniques. Additionally, we seek to determine whether ultrasound-guided or non-ultrasound-guided percutaneous release yields better outcomes compared to open surgery.
Materials & MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) published up to January 2024 was conducted, comparing percutaneous release to open surgical A1 pulley release for trigger finger treatment. The primary outcomes were divided into immediate post-operative, short-term and mid-term categories, and included post-operative motor function, post-operative pain, complication rate, and revision rate. Secondary outcomes focused on the complication and revision rates of ultrasound-guided versus non-ultrasound-guided percutaneous release compared to open surgery.
ResultsThirteen randomized controlled trials with a total of 956 patients were included in this study. Short-term post-operative motor function, measured by days to return to daily work (1.94 days, 95% confidence interval [CI], 0.47-3.41, p < 0.001), Q-DASH scores (24.94, 95% CI, 11.82–38.06, p = 0.77), and days of post-operative painkiller use (4.66 days, 95% CI, 1.77-7.55, p=0.42), indicated better outcomes with percutaneous release compared to open surgery. No significant differences were observed between percutaneous release and open surgery for long-term post-operative motor function, complication rates, and revision rates. Both non-ultrasound-guided and ultrasound-guided percutaneous release showed no difference in complication and revision rates compared to open surgery.
ConclusionIn terms of short-term outcomes, such as time to return to daily routine and cessation of painkiller use, percutaneous release is superior to open surgery. However, for long-term outcomes, there are no significant differences between
these two techniques.
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