Introduction
Methods
Study design
Inclusion and exclusion criteria
Database search terms
Risk of bias and quality assessment
Outcome measurement and definition
Statistical analysis
Result
Literature search
Study characteristics, risk of bias, and quality assessment
Study
|
Study design
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Publication year
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Country
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Number (hands)
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Gender (F/M)
|
Age (year)
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Treatment
|
Study visits (week postoperative)
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Efficacy variables
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Complication
|
---|---|---|---|---|---|---|---|---|---|---|
Agee 1992 | Randomized Ten-center study | 1992 | US | ECTR: 65 OCTR: 82 147 hands in 122 patients | UN | UN | Agee’s one-portal procedure Regional block or general anesthesia | 1, 2, 3, 6, 9, 13, 26 | Grip strength, pinch strength, Semmes-Weinstein monofilament sensory mapping, Phalen’s wrist flexion test, Tinel’s test, manual motor testing, time return to work | ECTR: 4/65 (2 partial transection, 2 transient ulnar neurapraxia) OCTR: 4/82 (1 deep motor branch of the ulnar nerve, 1 bowstringing of the digital flexor tendons, 2 wound dehiscence) |
Brown 1993 | Prospective, multicenter, randomized study | 1993 | US | ECTR: 84 OCTR: 85 169 hands in 151 | 31/53 23/62 | 57 55 | Two-portal technique | 3, 6, 12 | Strength, pinch strength, satisfaction, pain | ECTR: 4/84 (1 partial transection, 2 nerve injury, 1 wound hematoma) OCTR: 0/85 |
Sennwald and Benedetti 1995 | Prospective randomized study | 1995 | Switzerland | ECTR: 25 OCTR: 22 | 19/6 18/4 | 48.6 57 | One-portal procedure Regional anesthesia | 4, 8, 12 | Pain, grip, key-pinch strength, and ability to return to work Operative time | ECTR: 1/25 (1 neurapraxia) OCTR: 2/22 (1 RSD, 1 hypotrophic scar) |
Dumontier 1995 | Prospective randomized study | 1995 | France | ECTR:56 OCTR:40 | 49/7 36/4 | 53.4 50.7 | Two-portal technique | 2, 4, 12 | Numbness, pain, return to work, pinch and grip strength | ECTR: 2/56 OCTR:2/40 (2 reflex sympathetic dystrophy for both groups) |
Jacobsen 1996 | Prospective randomized study | 1996 | Sweden | ECTR: 16 OCTR: 16 29 patients | 11/5 12/4 | UN | Two-portal technique | 2, 6, 24 | Return to work, patient satisfaction | ECTR: 3/16 (3 transient numbness) OCTR: 0/16 |
MacDermid 2003 | Prospective randomized study | 2003 | Canada | ECTR: 91 OCTR: 32 | 62/29 22/10 | 45 53 | Two-portal Chow’s procedure | 1, 6, 12 | Symptom severity, pain, pinch, grip strength, satisfaction | ECTR: 0/91 OCTR: 0/32 |
Ferdinand 2002 | Prospective randomized blinded study | 2002 | Scotland | ECTR: 25 OCTR: 25 | 20/5 20/5 | 54.88 | Two-portal | 6, 12, 26, 52 | Return to work, day off ADL score, satisfaction, operative time | ECTR: 1/25 (wound pain) OCTR: 3/25 (2 persisting pain, 1 nerve injury) |
Trumble 2002 | Prospective multicenter randomized study | 2002 | US | ECTR: 97 OCTR: 95 | 48/27 47/25 | 56 56 | One-portal | 2, 4, 8, 12, 26, 52 | Symptom severity score, function score, operative time, satisfaction score, median time return to work, cost | ECTR: 0/97 OCTR: 2/95 (2 reflex sympathetic dystrophy) |
Wong 2003 | Prospective randomized study | 2003 | HK | ECTR: 30 OCTR: 30 | 28/2 28/2 | 47 47 | Two-portal Intravenous regional block | 2, 4, 8, 12, 16, 24, 48 | Wound and pillar pain, pinch and grip strength, two-point discrimination power, operative time | ECTR: 0/30 OCTR: 0/30 |
Atroshi 2006 | Prospective randomized study | 2006 | Sweden | ECTR: 63 OCTR: 65 | 44/19 52/13 | 44 44 | Two-portal technique | 3, 6, 12, 48 | Pain in scar, median postoperative work absence, severity of symptom, functional score, QOL, hand sensation, operative time | ECTR: 2/63 (2 recurrence of symptoms, 1 for OCTR) OCTR: 1/65 |
Soichi Ejiri 2012 | Prospective randomized controlled study | 2012 | Japan | ECTR: 51 OCTR: 50 | 48/3 43/7 | 59 58 | Okutsu’s one-portal technique Local anesthesia | 4, 12 | Change in subjective symptom, impairment in daily activity, APB-DL, sensation, muscle strength | ECTR: 3/51 (3 exacerbation of symptoms) OCTR: 0/50 |
Larsen 2013 | Prospective Single-blind randomized controlled study | 2013 | Denmark | ECTR: 30 OCTR: 30 | 22/8 48/12 | 54 45 | One-portal technique | 1, 2, 3, 6, 12, 24 | Pain VAS score, paresthesia, grip strength, range of motion, pillar pain, duration of sick leave | ECTR: 2/302 (neurapraxia) OCTR: 2/60 (2 infection) |
Ho Jung Kang 2013 | Prospective randomized controlled study | 2013 | South Korea | ECTR: 52 OCTR: 52 | 48/4 48/4 | 55 55 | One-portal technique General anesthesia | 12 | BCTQ-S, BCTQ-F, DASH, intraoperative tourniquet time, pain, scar or pillar pain | UN |
Study included
|
Study design
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Randomization
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Blind method
|
Allocation concealment
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Withdraw and dropout
|
Revised Jadad score
|
Level of evidence
|
---|---|---|---|---|---|---|---|
Agee 1992 | RCT | 1 | 1 | 0 | 1 | 3 | II |
Brown 1993 | RCT | 2 | 1 | 0 | 1 | 4 | II |
Sennwald and Benedetti 1995 | RCT | 2 | 1 | 0 | 1 | 4 | II |
Dumontier 1995 | RCT | 2 | 1 | 0 | 1 | 4 | II |
Jacobsen 1996 | RCT | 1 | 1 | 0 | 1 | 3 | II |
MacDermid 2003 | RCT | 2 | 1 | 0 | 1 | 4 | II |
Ferdinand 2002 | RCT | 2 | 1 | 0 | 1 | 4 | II |
Trumble 2002 | RCT | 2 | 2 | 0 | 0 | 4 | II |
Wong 2003 | RCT | 2 | 2 | 0 | 1 | 5 | II |
Atroshi 2006 | RCT | 2 | 1 | 0 | 1 | 4 | II |
Soichi Ejiri 2012 | RCT | 2 | 2 | 0 | 0 | 4 | II |
Larsen 2013 | RCT | 2 | 2 | 0 | 1 | 4 | II |
Ho Jung Kang 2013 | RCT | 2 | 2 | 1 | 1 | 5 | II |
Heterogeneity of studies
Primary outcome: complications
Operative time
Patient subjective satisfaction
Hand grip and pinch strength
Pain rate
Time to return to work
Outcomes
|
Number of studies
|
Heterogeneity
I
2a
(%)
|
Pooled relative risk
b
|
Mean difference
|
95% confidence interval
|
---|---|---|---|---|---|
Operative time | 5 | 97 | NA | −1.89 | [−5.84, 2.06] |
Patient’s satisfaction | 4 | 21 | 1.0 | NA | [0.93, 1.08] |
Grip strength | 2 | 0 | NA | 2.39 | [−0.95, 5.73] |
Pinch strength | 2 | 87 | NA | −0.53 | [−3.16, 2.11] |
Return to work | 2 | 0 | NA | −3.52 | [−8.15, 1.10] |
Complication | 13 | 0 | 1.34 | NA | [0.74, 2.43] |
Two-portal technique | 7 | 23 | 1.74 | NA | [0.71, 4.23] |
One-portal technique | 6 | 0 | 1.06 | NA | [0.47, 2.40] |
Nerve injury | 8 | 0 | 2.38 | NA | [0.98, 5.77] |