Simple decompression vs. subcutaneous anterior transposition of the ulnar nerve: the 2025 update on the optimal treatment for cubital tunnel syndrome

This 2024 update aims to compare the clinical outcomes, recurrence, and revision rates between simple decompression (SD) and subcutaneous anterior transposition (SAT) of the ulnar nerve for treating cubital tunnel syndrome (CuTS). A systematic review of articles from PubMed, Scopus, and Google Scholar was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We selected all English-language comparative studies published from January 2000 to June 2024, comparing SD and SAT concerning postoperative outcomes of surgical treatment for CuTS. Ten articles met the inclusion criteria. We found no statistical difference in the clinical outcomes of SD and SAT. Two studies indicated SD was superior to SAT. Four studies concluded that both techniques were equally effective for CuTS treatment. Three studies were inconclusive, and one study reported <i>in situ</i> decompression as inferior to SAT, with a high recurrence rate. As of 2025, the surgical approach to CuTS remains consistent with current practice. Both SD and SAT of the ulnar nerve continue to demonstrate good clinical outcomes. Although SD may be associated with higher rates of recurrences and revision surgeries, no clear superiority of one technique over the other has been established.