Subcutaneous Versus Submuscular Anterior Transposition of the Ulnar Nerve for XXXX : A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.

@entity1 @entity7769 @entity16 @entity23 @entity601
Subcutaneous and submuscular anterior ulnar nerve transposition have been widely used in @entity1 with @entity7769 . However, the reliable evidence in favor of 1 of 2 surgical options on clinical improvement remains controversial. To maximize the value of the available literature, we performed a systematic review and meta-analysis to compare subcutaneous versus submuscular anterior ulnar nerve transposition in @entity1 with @entity16 at the elbow. PubMed, Cochrane Library, and EMBASE databases were searched for randomized and observational studies that compared subcutaneous transposition with submuscular transposition of ulnar nerve for @entity7769 . The primary outcome was clinically relevant improvement in function compared to the baseline. Randomized and observational studies were separately analyzed with relative risks (RRs) and 95% confidence intervals (CIs). Two @entity23 ( @entity23 ) and 7 observational studies, involving 605 @entity1 , were included. Our meta-analysis suggested that no significant differences in the primary outcomes were observed between comparison groups, both in RCT (RR, 1.16; 95% CI 0.68-1.98; P = 0.60; I2= 81%) and observational studies (RR, 1.01; 95% CI 0.95-1.08; P = 0.69; I2 = 0%). These findings were also consistent with all subgroup analyses for observational studies. In the secondary outcomes, the incidence of adverse events was significantly lower in subcutaneous group than in submuscular group (RR, 0.54; 95% CI 0.33-0.87; P = 0.01; I2 = 0%), whereas subcutaneous transposition failed to reveal more superiority than submuscular transposition in static two-point discrimination ( @entity601 , 0.04; 95% CI -0.18-0.25; P = 0.74; I = 0%). The available evidence is not adequately powered to identify the best anterior ulnar nerve transposition technique for @entity7769 on the basis of clinical outcomes, that is, suggests that subcutaneous and submuscular anterior transposition might be equally effective in terms of postoperative clinical improvement. However, differences in clinical outcomes metrics should be noted, and these findings largely rely on the outcomes data from observational studies that are potentially subject to a high risk of selection bias. Therefore, more high-quality and adequately powered @entity23 with standardized clinical outcomes metrics are necessary for proper comparison of these techniques.
