Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis

PLoS One. 2015 Dec 16;10(12):e0143683. doi: 10.1371/journal.pone.0143683. eCollection 2015.


Background: The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather "blind" procedure and on the high number of severe complications that have been reported in the literature.

Purpose: To evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release.

Methods: We searched MEDLINE (January 1966 to November 2013), EMBASE (January 1980 to November 2013), the Cochrane Neuromuscular Disease Group Specialized Register (November 2013) and CENTRAL (2013, issue 11 in The Cochrane Library). We hand-searched reference lists of included studies. We included all randomized or quasi-randomized controlled trials (e.g. study using alternation, date of birth, or case record number) that compare any ECTR with any OCTR technique. Safety was assessed by the incidence of major, minor and total number of complications, recurrences, and re-operations.The total time needed before return to work or to return to daily activities was also assessed. We synthesized data using a random-effects meta-analysis in STATA. We conducted a sensitivity analysis for rare events using binomial likelihood. We judged the conclusiveness of meta-analysis calculating the conditional power of meta-analysis.

Conclusions: ECTR is associated with less time off work or with daily activities. The assessment of major complications, reoperations and recurrence of symptoms does not favor either of the interventions. There is an uncertain advantage of ECTR with respect to total minor complications (more transient paresthesia but fewer skin-related complications). Future studies are unlikely to alter these findings because of the rarity of the outcome. The effect of a learning curve might be responsible for reduced recurrences and reoperations with ECTR in studies that are more recent, although formal statistical analysis failed to provide evidence for such an association.

Level of evidence: I.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Carpal Tunnel Syndrome / surgery*
  • Endoscopy / adverse effects
  • Endoscopy / methods*
  • Humans
  • Odds Ratio
  • Postoperative Complications
  • Recurrence
  • Retreatment
  • Treatment Outcome

Grants and funding

GS, AC and HV received funding from the European Research Council (IMMA, grant no. 260559). HV received travel support from the manufacturer of instrumentation (Stryker) for mini-open and endoscopic release to attend an orthopedic conference. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.