Comparison of amniotic membrane transplantation and carpal tunnel syndrome release surgery (CTRS) and CTRS alone: Clinical outcomes at 1‐year follow‐up

Abstract

Carpal tunnel syndrome (CTS) is the most common focal entrapment mononeuropathy, comprising medium nerve chronic inflammation and fibrosis.Although carpal tunnel release surgery (CTRS) has demonstrated to be effective, around 3% to 25% of CTRS show recurrence. Amniotic membrane transplantation (AMT) has been used in different pathologies inhibiting inflammation and fibrosis and promoting nerve repair. The aim of this study was to determine the efficacy of AMT in CTRS. The present study comprised a randomized, single-blind controlled trial to compare the 1-year follow-up outcomes of AMT in CTRS (AMT group) or CTRS alone (control group) in patients with CTS. Thirty-five patients with unilateral or bilateral CTS were enrolled, and 47 wrists were randomized into two groups: the AMT group and the control group. To compare the outcomes, three different questionnaires scores (Boston Carpal Tunnel Syndrome Questionnaire, Disabilities of the Arm, Shoulder, and Hand, and Historical-Objective scale) were used. Evaluations were assessed at baseline and at 15 days, 1, 3, 6, and 12 months after surgery. Compared with the control group, the AMT group showed significant (p < 0.05) reductions in all scores from 6 months after surgery until the end of the study. Both AMT and control groups showed significant intragroup differences in all scores, since the first month after surgery until the end of the study in comparison with the baseline scores. Taken together, these results indicate that CTRS in conjunction with AMT is more effective than CTRS alone in patients with CTS at 1-year follow-up.

Functional Recovery after the Application of Amniotic Tissues and Methylene Blue during Radical Prostatectomy—A Pilot Study

“…Immunohistochemistry showed reduced macrophages, collagen formation, and an increased detection of nerve growth factor [ 26 ]. Other experimental and small clinical studies used the amnion for nerve regeneration; for example, in thyroid surgery and carpal tunnel syndrome [ 27 , 28 ]. In a retrospective evaluation of the use of the dehydrated amnion/chorion (AmnioFix) as part of a nerve-sparing robotic radical prostatectomy (RP), an American study was able to show a faster return to potency and continence without any increased risk of recurrence at a median follow up of 4 months [ 29 ].…”

Does Recurrence of Carpal Tunnel Syndrome (CTS) after Complete Division of the Transverse Ligament Really Exist?

“…The aim of surgical treatment of CTS is to completely sever the transverse carpal ligament in order to decompress the canal and the median nerve. For this purpose, several surgical techniques are at hand, including open and closed techniques [ 11 , 13 , 20 , 21 ]. In our study, all revision surgeries were performed with open techniques.…”

“…The aim of all three operating techniques is to completely sever the transverse carpal ligament and, thus, to decompress the median nerve within the carpal tunnel [ 10 , 11 , 12 ].…”

Biological properties and surgical applications of the human amniotic membrane

“…The different properties of AM have favored the repair of osteomuscular injuries in the area of traumatology in conditions such as carpal tunnel release surgery (CTRS) using frozen AM as a treatment for carpal tunnel syndrome, where the function of inhibiting inflammation, fibrosis, and favoring nerve repair is obtained by adhering AM in the median nerve, which in turn can improve clinical symptomatology compared to CTRS alone ( Buentello-Volante et al, 2020 ). It also has anti-adhesion capacity in tendon repair, for example in the flexor tendon in zone II, as well as promoting tendon healing ( Demirkan et al, 2002 ; Liu et al, 2019 ).…”