INTRODUCTION: A meta-analysis was undertaken to improve our understanding of the inconsistencies in the benefit of the Endoscopic Carpal Tunnel Release (ECTR). By combining the results of the small published studies that compared ECTR to OCTR (open carpal tunnel release), we hoped to create more precise, powerful and convincing conclusions.

METHODOLOGY: The following outcome criteria measuring clinical status were identified a priori: relief of symptoms, grip strength, pinch strength, days to return to work/activities of daily living. In addition the following adverse effects were considered: irreversible nerve damage, reversible nerve damage (neuropraxia) and RSD.

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Thirteen Randomized Controlled Trials (RCTs) were identified: 5 published in English, 4 in German, 2 in Dutch, 1 in Portuguese and 1 in French. Validity assessments were undertaken and the studies were graded using the Jadad scale (Jadad et al 1996). The data from these studies were combined using a Fixed-Effects model and a Random-Effects model if the studies were statistically homogeneous. The ODDS ratio was used as the summary estimate of the effect.

RESULTS:

The synthesis was limited to few discrete outcomes with a limited follow-up of 12 weeks. These were: Irreversible nerve damage, Reversible nerve damage, Grip strength, Pinch strength, Scar Tenderness and Pain.

For reversible nerve damage, the Pooled ODDS ratio using the fixed and random effects model was 3.07 (CI 1.10-8.56) suggesting that this complication is more likely to occur with ECTR than OCTR.

For the outcome , Grip Strength only the Random Effects model was appropriate and the pooled effect size was 0. 682 (CI 0.06-1.30) favoring the ECTR .

For Pinch Strength the pooled effect size using the fixed effects model is 0.375 (CI 0.09-0.66) which is the same as the random effects model favoring the ECTR.

For Scar Tenderness the pooled ODDS ratio using the fixed effects model was 0.265 (CI 0.15-0.46) and the random effects model estimate was 0.177 (CI 0.15-0.46) favoring the ECTR.

For pain the pooled ODDS ratio for the random effects model was 0.435 (CI 0.05-4.07) favoring the ECTR.

CONCLUSIONS:

This meta-analysis shows no clear cut superiority of the ECTR over the OCTR. On a short follow-up the ECTR is superior in terms of pain, grip strength, pinch strength, tenderness but it is inferior to OCTR as it is associated with worse outcome in reversible nerve damage.

The definitive answer to the ongoing controversy can only be answered with a large methodologically sound RCT.