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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

Forest plot of comparison: 1 Clinical effect of subcutaneous versus submuscular, outcome: 1.1 Proportion of patients with clinical improvement in function compared to baseline.
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pone.0130843.g004: Forest plot of comparison: 1 Clinical effect of subcutaneous versus submuscular, outcome: 1.1 Proportion of patients with clinical improvement in function compared to baseline.

Mentions: We found clinical improvement compared to baseline in 98.3% of the patients treated with subcutaneous transposition and in 96.7% of those treated with submuscular transposition. No significant difference was observed in postoperative clinical improvement between two treatment groups (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). (Analysis 1.1, Fig 4). A random-effects model was applied because statistical evidence of heterogeneity was found (P = 0.009, I2 = 79%). Sensitivity analysis revealed that heterogeneity may be attributed to the inclusion of the study reported by Jaddue [16] et al, in which participant populations compared to remaining studies were relatively small. Eliminating this study from the analysis showed a substantially reduced heterogeneity (P = 0.95, I2 = 1%). But we did not drop this study because only three included studies provided the clinically relevant improvement information and moderate methodological quality of the evidence.


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)

Forest plot of comparison: 1 Clinical effect of subcutaneous versus submuscular, outcome: 1.1 Proportion of patients with clinical improvement in function compared to baseline.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0130843.g004: Forest plot of comparison: 1 Clinical effect of subcutaneous versus submuscular, outcome: 1.1 Proportion of patients with clinical improvement in function compared to baseline.
Mentions: We found clinical improvement compared to baseline in 98.3% of the patients treated with subcutaneous transposition and in 96.7% of those treated with submuscular transposition. No significant difference was observed in postoperative clinical improvement between two treatment groups (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72). (Analysis 1.1, Fig 4). A random-effects model was applied because statistical evidence of heterogeneity was found (P = 0.009, I2 = 79%). Sensitivity analysis revealed that heterogeneity may be attributed to the inclusion of the study reported by Jaddue [16] et al, in which participant populations compared to remaining studies were relatively small. Eliminating this study from the analysis showed a substantially reduced heterogeneity (P = 0.95, I2 = 1%). But we did not drop this study because only three included studies provided the clinically relevant improvement information and moderate methodological quality of the evidence.

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