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Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Liu CH, Chen CX, Xu J, Wang HL, Ke XB, Zhuang ZY, Lai ZL, Wu ZQ, Lin Q - PLoS ONE (2015)

Bottom Line: The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline.Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72).Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.

ABSTRACT

Objective: To pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.

Methods: A comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.

Results: Three studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was 'low' or 'moderate' on the basis of GRADE approach.

Conclusions: Based on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore, more high-quality randomized controlled trials with standardized clinical improvement metrics are required to further clarify this topic and to provide reproducible pre- and postoperative objective outcomes.

No MeSH data available.


Related in: MedlinePlus

Risk of bias graph: Each risk of bias assessment was presented as the percentage across all the included studies, which indicates the proportion of different levels of risk of bias for each item.
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pone.0130843.g003: Risk of bias graph: Each risk of bias assessment was presented as the percentage across all the included studies, which indicates the proportion of different levels of risk of bias for each item.

Mentions: The methodological quality of each included study has been described in Fig 2 and the judgment of “Risk of bias graph” regarding each risk of bias assessment was presented as percentages across all the three included studies in Fig 3. Among the three included studies, two RCTs [14, 15] described adequate methods of randomization, which a computer-generated list was used to randomize the participants in Zhong’s study [14] while Zarezadeh’s study [15] was based on a random table numbers. The participants of the quasi-RCT [16] were randomly assigned by age (2 years margin) and gender. Since no concrete allocation concealment method was described in three included studies [14–16], we described these studies as unclear of allocation concealment. It was not clear whether participants were blinded to the operation in Jaddue’s studies [16], and they were not blinded in two [14, 15] of the three included studies. In two studies [15, 16] all participants were evaluated by the same independent assessors while the other one [14] did not. In these studies no participant was lost to follow-up, so we regarded the included studies as low risk of incomplete outcome data. We also considered all of these studies as low risk of selective outcome reporting for they described complete outcomes in detail. Other potential sources of bias were unclear in 3 included studies since none of the studies mentioned whether or not they had raised funding in support of their research.


Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Liu CH, Chen CX, Xu J, Wang HL, Ke XB, Zhuang ZY, Lai ZL, Wu ZQ, Lin Q - PLoS ONE (2015)

Risk of bias graph: Each risk of bias assessment was presented as the percentage across all the included studies, which indicates the proportion of different levels of risk of bias for each item.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482721&req=5

pone.0130843.g003: Risk of bias graph: Each risk of bias assessment was presented as the percentage across all the included studies, which indicates the proportion of different levels of risk of bias for each item.
Mentions: The methodological quality of each included study has been described in Fig 2 and the judgment of “Risk of bias graph” regarding each risk of bias assessment was presented as percentages across all the three included studies in Fig 3. Among the three included studies, two RCTs [14, 15] described adequate methods of randomization, which a computer-generated list was used to randomize the participants in Zhong’s study [14] while Zarezadeh’s study [15] was based on a random table numbers. The participants of the quasi-RCT [16] were randomly assigned by age (2 years margin) and gender. Since no concrete allocation concealment method was described in three included studies [14–16], we described these studies as unclear of allocation concealment. It was not clear whether participants were blinded to the operation in Jaddue’s studies [16], and they were not blinded in two [14, 15] of the three included studies. In two studies [15, 16] all participants were evaluated by the same independent assessors while the other one [14] did not. In these studies no participant was lost to follow-up, so we regarded the included studies as low risk of incomplete outcome data. We also considered all of these studies as low risk of selective outcome reporting for they described complete outcomes in detail. Other potential sources of bias were unclear in 3 included studies since none of the studies mentioned whether or not they had raised funding in support of their research.

Bottom Line: The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline.Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72).Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medical, Quanzhou, Fujian Province, China.

ABSTRACT

Objective: To pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.

Methods: A comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR) and 95% confidence intervals (CI) were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.

Results: Three studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was 'low' or 'moderate' on the basis of GRADE approach.

Conclusions: Based on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore, more high-quality randomized controlled trials with standardized clinical improvement metrics are required to further clarify this topic and to provide reproducible pre- and postoperative objective outcomes.

No MeSH data available.


Related in: MedlinePlus