Where do we stand with revision surgery for recurrent carpal tunnel syndrome? A systematic review☆
4 affiliations
- 1Imperial College London, United Kingdom
- 2Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
- 3School of Clinical Medicine, University of Cambridge, United Kingdom
- 4Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
Abstract
Introduction: Recurrent carpal tunnel syndrome (CTS) after carpal tunnel release may require revision surgery, but the relative value of decompression, neurolysis, vascularised coverage, nerve wrapping, fat grafting, and other adjuncts remains uncertain. This study synthesised patient-reported outcomes, complications, and re-revision after revision surgery for recurrent CTS, with emphasis on mechanism-based interpretation rather than technique superiority.
Methods: A PRISMA-guided systematic review was performed across PubMed, EMBASE, Scopus, Web of Science and CENTRAL (PROSPERO CRD420261323775). Studies of adults undergoing revision surgery for recurrent CTS and reporting clinical outcomes were included. Owing to heterogeneity in recurrence definitions, operative indications, surgical techniques, follow-up, and outcome reporting, findings were synthesised narratively.
Results: Thirty-five studies (816 patients, 844 hands) were analysed. Most studies were retrospective single-arm case series with heterogeneous definitions, indications, techniques, and outcome measures. Revision surgery was generally associated with symptomatic improvement. Descriptively, pooled VAS improvement was 5.60 points in flap cohorts and 4.08 points in non-flap cohorts, with substantial heterogeneity. Patient-reported outcomes generally improved when reported, but use of validated outcomes was inconsistent. Complications were infrequent. Re-revision was uncommon overall, occurring in 25 cases, representing 3.1% of reported cases, but sparse events and variable follow-up limited interpretation.
Conclusion: Revision surgery for recurrent CTS is generally associated with improved symptoms, but current evidence cannot establish superiority of any technique. Re-revision is best interpreted as an observational durability outcome. Operative planning should be guided by the primary mechanism of failure rather than the presumed superiority of any single revision strategy.
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BibTeX
@article{kiew2026where,
title = {{Where do we stand with revision surgery for recurrent carpal tunnel syndrome? A systematic review☆}},
author = {Cheuk Ying Kyleen Kiew and Rachel Jia En Lai and David Kwan Ryung Lee and Dave Osinachukwu Duru and Wee Leon Lam},
journal = {JPRAS Open},
year = {2026},
month = aug,
doi = {10.1016/j.jpra.2026.07.039},
url = {https://doi.org/10.1016/j.jpra.2026.07.039},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Where do we stand with revision surgery for recurrent carpal tunnel syndrome? A systematic review☆
AU - Cheuk Ying Kyleen Kiew
AU - Rachel Jia En Lai
AU - David Kwan Ryung Lee
AU - Dave Osinachukwu Duru
AU - Wee Leon Lam
PY - 2026
DA - 2026/08/06
JO - JPRAS Open
DO - 10.1016/j.jpra.2026.07.039
UR - https://doi.org/10.1016/j.jpra.2026.07.039
AB - Introduction: Recurrent carpal tunnel syndrome (CTS) after carpal tunnel release may require revision surgery, but the relative value of decompression, neurolysis, vascularised coverage, nerve wrapping, fat grafting, and other adjuncts remains uncertain. This study synthesised patient-reported outcomes, complications, and re-revision after revision surgery for recurrent CTS, with emphasis on mechanism-based interpretation rather than technique superiority. Methods: A PRISMA-guided systematic review was performed across PubMed, EMBASE, Scopus, Web of Science and CENTRAL (PROSPERO CRD420261323775). Studies of adults undergoing revision surgery for recurrent CTS and reporting clinical outcomes were included. Owing to heterogeneity in recurrence definitions, operative indications, surgical techniques, follow-up, and outcome reporting, findings were synthesised narratively. Results: Thirty-five studies (816 patients, 844 hands) were analysed. Most studies were retrospective single-arm case series with heterogeneous definitions, indications, techniques, and outcome measures. Revision surgery was generally associated with symptomatic improvement. Descriptively, pooled VAS improvement was 5.60 points in flap cohorts and 4.08 points in non-flap cohorts, with substantial heterogeneity. Patient-reported outcomes generally improved when reported, but use of validated outcomes was inconsistent. Complications were infrequent. Re-revision was uncommon overall, occurring in 25 cases, representing 3.1% of reported cases, but sparse events and variable follow-up limited interpretation. Conclusion: Revision surgery for recurrent CTS is generally associated with improved symptoms, but current evidence cannot establish superiority of any technique. Re-revision is best interpreted as an observational durability outcome. Operative planning should be guided by the primary mechanism of failure rather than the presumed superiority of any single revision strategy.
SN - 2352-5878
ER -