Simple Decompression versus Anterior Transposition (Submuscular and Subcutaneous) of the Ulnar Nerve in Cubital Tunnel Syndrome: a Meta-Analysis

Cubital tunnel syndrome (CTS) is the second most common neuropathy of the upper extremity due to entrapment of ulnar nerve. Surgical management is the better intervention compared with conservative one. This study is to evaluate operative technique preferable for the treatment of cubital tunnel syndrome and compare between simple decompression versus anterior transposition, and subcutaneous anterior transposition versus sub muscular anterior transposition. Level III systematic review and network meta-analysis were performed to compare clinical improvement between subcutaneous anterior transposition and sub muscular anterior transposition, and simple decompression and anterior transposition. Two sub analysis was also performed: 1) comparing sub muscular anterior transposition to subcutaneous anterior transposition, 2) comparing Infection rate of Simple Decompression to Anterior transposition. We identified eighteen studies in which 5 studies were RCT and 13 were non RCT (8 Retrospective Case series and 5 Prospective study) which involved a total number of 491 simple decompressions, 307 sub muscular transpositions and 485 subcutaneous transposition patients. We also found evidence of publication bias or statistical study heterogeneity. Odds ratio of improvement with simple decompression versus anterior transposition were 0.781 with a 95% CI of [0.574, 1.063], I2 = 0%, p value =0.117. The odds ratio of improvement of subcutaneous transposition versus sub muscular transposition was 1.208 with a 95% CI of [0.609, 2.397], I2 = 0%, p value=0.588 and the odds ratio of post-op infection in simple decompression versus anterior transposition was 0.287 with 95% CI of [0.097, 0.845], I2 = 0%, with p value=0.024. Sensitivity analyses with use of fixed-effects methodology confirmed these findings to be robust and no heterogeneity was found. The result in this study showed that there is no significant difference between the treatment of cubital tunnel syndrome while comparing the improvement parameter for simple decompression vs anterior transposition and sub muscular transposition vs subcutaneous transposition but while doing a sub-analysis comparing the post op-infection between simple decompression and anterior transposition significant difference was found, and also with subcutaneous transposition and sub muscular transposition.