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Background <p>Recurrent or persistent carpal tunnel syndrome presents a significant therapeutic challenge, with around 5% to 10% of patients experiencing failure after initial surgical management. When simple re-release is not feasible due to extensive scarring or multiple previous surgeries, autologous nerve coverage techniques offer an alternative approach. However, the optimal coverage technique remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes across different autologous nerve coverage techniques and identify factors influencing success.</p> Methods <p>Following PRISMA 2020 guidelines, we searched multiple databases without date or language restrictions. Studies including at least ten-patients undergoing autologous nerve coverage for recurrent/persistent carpal tunnel syndrome were included. Primary outcomes included overall improvement, complete symptom relief, patient satisfaction, and pain improvement. Random-effects meta-analysis was performed, and correlations between biological properties and outcomes were analyzed.</p> Results <p>Twenty-six studies with total of 585 patients and 607 hands, evaluating eight different techniques were included. The hypothenar fat pad flap demonstrated superior complete symptom resolution (69.7%, 95%CI:61.1–78.4%) compared to the synovial flap (26.3%, 95%CI:17.6–34.9%). Longer intervals between surgeries (OR:2.36, <i>P</i>-value = 0.001), fewer prior procedures (OR:3.57, <i>P</i>-value &lt; 0.001), and absence of diabetes (OR:0.47, <i>P</i>-value = 0.002) or rheumatoid arthritis (OR:0.35, <i>P</i>-value = 0.003) strongly predicted favorable outcomes. Regenerative potential (<i>r</i> = 0.53, <i>P</i>-value = 0.015), vascularization (<i>r</i> = 0.48, <i>P</i>-value = 0.037), and tissue thickness (<i>r</i> = 0.41, <i>P</i>-value = 0.044) significantly correlated with success.</p> Conclusions <p>The hypothenar fat pad flap achieves the best outcomes for most revision scenarios due to its balanced biological properties. When feasible, revision surgery should be delayed beyond 12-months from first procedure. Patient-specific factors significantly impact outcomes and should guide technique selection. Future studies should focus on prospective comparative studies with standardized outcome measures and validated risk stratification models to refine patient-specific treatment algorithms. </p> <p>Level of Evidence: Not gradable.</p>

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Optimizing autologous nerve coverage techniques for recurrent carpal tunnel syndrome: a meta-analysis and predictive modeling framework

  • 期刊论文

  • 发表日期：

    2025年6月19日

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  • Yazan Jumah Alalwani,
  • Nihal Mushabb Alqahtani,
  • Imtinan Al Jabbar,
  • Roaa Abdulkarim Alghamdi,
  • Mujtaba Hussain Alobaid,
  • Rahaf Hamdan Alruwaili,
  • Raghad Yaser Sonbul,
  • Osama Khalid Alharbi,
  • Rana Ali Hassan Arab,
  • Tala Ahmed Alkhunani,
  • Amre S. Hamdi,
  • Ahmed Y. Azzam,
  • Bayan A. Ghalimah

摘要

Background

Recurrent or persistent carpal tunnel syndrome presents a significant therapeutic challenge, with around 5% to 10% of patients experiencing failure after initial surgical management. When simple re-release is not feasible due to extensive scarring or multiple previous surgeries, autologous nerve coverage techniques offer an alternative approach. However, the optimal coverage technique remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes across different autologous nerve coverage techniques and identify factors influencing success.

Methods

Following PRISMA 2020 guidelines, we searched multiple databases without date or language restrictions. Studies including at least ten-patients undergoing autologous nerve coverage for recurrent/persistent carpal tunnel syndrome were included. Primary outcomes included overall improvement, complete symptom relief, patient satisfaction, and pain improvement. Random-effects meta-analysis was performed, and correlations between biological properties and outcomes were analyzed.

Results

Twenty-six studies with total of 585 patients and 607 hands, evaluating eight different techniques were included. The hypothenar fat pad flap demonstrated superior complete symptom resolution (69.7%, 95%CI:61.1–78.4%) compared to the synovial flap (26.3%, 95%CI:17.6–34.9%). Longer intervals between surgeries (OR:2.36, P-value = 0.001), fewer prior procedures (OR:3.57, P-value < 0.001), and absence of diabetes (OR:0.47, P-value = 0.002) or rheumatoid arthritis (OR:0.35, P-value = 0.003) strongly predicted favorable outcomes. Regenerative potential (r = 0.53, P-value = 0.015), vascularization (r = 0.48, P-value = 0.037), and tissue thickness (r = 0.41, P-value = 0.044) significantly correlated with success.

Conclusions

The hypothenar fat pad flap achieves the best outcomes for most revision scenarios due to its balanced biological properties. When feasible, revision surgery should be delayed beyond 12-months from first procedure. Patient-specific factors significantly impact outcomes and should guide technique selection. Future studies should focus on prospective comparative studies with standardized outcome measures and validated risk stratification models to refine patient-specific treatment algorithms.

Level of Evidence: Not gradable.