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Endoscopic decompression of the ulnar nerve in the cubital tunnel yields similar outcomes but a lower complication rate than open decompression: a systematic review and meta-analysis
  1. Kyle R Sochacki,
  2. Derek T Bernstein,
  3. Joshua D Harris,
  4. Shari R Liberman
  1. Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
  1. Correspondence to Dr Kyle R Sochacki; Houston Methodist Hospital, 6445 Main Street, Suite 2500, Houston, TX 77030, USA; ksochacki{at}


Importance Cubital tunnel syndrome is the second most common peripheral nerve compression syndrome in the USA. There is controversy in the literature regarding the best surgical option.

Objective The purpose of this investigation was to perform a systematic review to determine if there is a difference in clinical outcomes or complications between open and endoscopic cubital tunnel release in patients with compression of the ulnar nerve in the cubital tunnel.

Evidence review A systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, SCOPUS and Cochrane Central Register of Controlled Trials databases were searched for level I–IV therapeutic comparative studies of open versus endoscopic cubital tunnel decompression in adult human patients. The levels of evidence were then assigned based on the Oxford Centre for Evidence-Based Medicine. Study methodological quality was analysed using the Modified Coleman Methodology Score. Only the outcome measurements that 3 or more studies used were included in our data synthesis. Postoperative patient satisfaction, Bishop score, recurrence and complication rates were compared between the endoscopic and open groups using the χ2 test using p<0.05.

Findings Six articles (507 patients, mean age of 48.2 years, with 28.8 months average follow-up) were analysed. 76.1% of patients were satisfied in the endoscopic group, and 73.8% were satisfied in the open group (p=0.7023). 87.4% of endoscopic patients and 81.2% of open patients had a Bishop score of excellent or good (p=0.236). The endoscopic group had a recurrence rate of 1.1%, and the open group had a 3.5% recurrence rate (p=0.0872). There were significantly fewer complications in the endoscopic group (7.9%) compared to the open group (12.9%) (p<0.01).

Conclusions and relevance Equivalent clinical outcomes, patient satisfaction and recurrence rates were observed between open and endoscopic techniques. However, a significantly lower complication rate was observed with the endoscopic technique.

Level of evidence Level IV, systematic review of level I–IV studies.

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  • Contributors All the authors have been actively involved in the planning and enactment of the study and have also assisted with the preparation of the submitted article. The manuscript has been read and approved by all authors.

  • Competing interests KRS, DTB and SRL declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article. JDH has the following disclosures: AAOS: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthroscopy: Editorial or governing board; Arthroscopy Association of North America: Board or committee member; DePuy, A Johnson and Johnson Company: research support; Frontiers in Surgery: Editorial or governing board; NIA Magellan: paid consultant; SLACK Incorporated: publishing royalties, financial or material support; Smith and Nephew: paid presenter or speaker and research support.

  • Provenance and peer review Commissioned; externally peer reviewed.

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