Autologous Fat Grafting and Neurolysis for Treatment of Recalcitrant Carpal Tunnel Syndrome.

PURPOSE: There is no consensus on the treatment for recalcitrant carpal tunnel syndrome (CTS), a problem caused mainly by fibrous perineural adhesions. Neurolysis is advised with or without the interposition of vascularized tissue, a labor-intensive process causing considerable donor site morbidity. Autologous fat grafting has less donor site morbidity, and adipose-derived stromal cells in adipose tissue might recover nerve damage and prevent adhesions. The authors hypothesized that neurolysis combined with autologous fat grafting improves symptoms and reduces CTS recurrence.

METHODS

Carpal tunnel syndrome patients with a second to fifth recurrence underwent neurolysis combined with perineural fat grafting using autologous lipoaspirate (n = 29). The Boston Carpal Tunnel Questionnaire was administered before surgery and twice during follow-up. The minimal clinically important difference was calculated individually for the symptom severity scale (SSS) and functional status scale (FSS). To determine whether patients experienced recurrence or required additional surgery, follow-up data were collected up to 5 years after surgery (range: 3-9.5 years).

RESULTS

The Boston Carpal Tunnel Questionnaire scores improved after surgery for 86% of the patients and remained stable during the follow-up. Accordingly, median (interquartile range) SSS and FSS scores decreased from 3.75 (2.75-4.38) to 2.12 (1.12-3.45) and 3.73 (3.27-4.18) to 1.86 (1.09-2.48) after surgery, respectively. This change in SSS or FSS scores exceeded the minimal clinically important difference in 79% of the patients. No patient underwent another surgical decompression during the follow-up.

CONCLUSIONS

Extensive neurolysis of the median nerve combined with perineural autologous fat grafting improves symptoms and prevents repetitive surgical treatment in the long-term in recalcitrant CTS.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.