Is the outcome of a revision carpal tunnel release as good as those of a primary release? A matched cohort study.

Objective: This study aimed to compare primary and revision carpal tunnel release outcomes in all patients with carpal tunnel syndrome and when corrected for baseline severity and demographics.

Methods: A total of 903 hands of primary and 132 hands of revision patients underwent carpal tunnel release and patients completed online questionnaires on demographics, clinical severity, and satisfaction. The primary outcome measure, the Boston Carpal Tunnel Questionnaire (BCTQ), was administered at intake and six months after surgery.

Results: The BCTQ total score at six months was better in primary (1.55±0.58) than revision patients (1.94±0.73, p=<0.001), and primary patients improved more on the BCTQ total score (1.10±0.71 vs. 0.90±0.72, p=0.003). In patients matched on similar baseline characteristics using propensity score matching, the BCTQ total score at six months was also better in primary patients (1.65±0.63) than in revision patients (1.92±0.73, p=0.002), and primary patients still had more improvement in BCTQ total score (1.18±0.73 vs. 0.89±0.73, p=0.004).

Conclusions: This study shows that the outcome after revision carpal tunnel release is only 16% worse compared to primary carpal tunnel release. Preoperative symptom severity, functional status, and demographics may play a role since correcting for these factors reduces the difference in outcome between primary and revision CTR.