Human Amniotic Membrane Wrapping of the Ulnar Nerve During Cubital Tunnel Surgery Reduces Recurrence of Symptoms

Background: Compare the recurrence rate of paresthesias in patients undergoing primary cubital tunnel surgery inthose with and without wrapping of the ulnar nerve with the human amniotic membrane (HAM).Methods: A retrospective investigation of patients undergoing primary cubital tunnel surgery with a minimum۹۰-day follow-up was performed. Patients were excluded if the nerve was wrapped using another material, associated traumatic injury,simultaneous Guyon’s canal release, or revision procedures. Failure was defined as those patients who experiencedinitial complete resolution of symptoms (paresthesias) but then developed recurrence of paresthesias.Results: A total of ۵۷ controls (CON) and ۲۱ treated with HAM met our inclusion criteria. There was a difference inthe mean age of CON (۴۸.۴ ± ۱۳.۵ years) and HAM (۳۰.۶ ± ۱۵) (P< ۰.۰۰۰۱). There was no difference in gender mix(P=۰.۴), the severity of symptoms (P=۰.۱۳), and length of follow-up (P=۰.۰۸۴). None of ۲۱ (۰%) treated with HAMdeveloped recurrence of symptoms compared to ۱۱ of ۵۷ (۱۹.۳%) (P=۰.۰۳) (CON). Using a multivariate regressionmodel adjusted for age and procedure type, CON was ۲۴.۴ (۹۵% CI=۱.۲۶-۵۰۰, P=۰.۰۳۴۸) times higher risk than HAMof developing a recurrence of symptoms.Conclusion: The HAM wrapping used in primary cubital tunnel surgery significantly reduced recurrence rates ofparesthesias. Further prospective studies with randomization should be carried out to better understand the role HAMcan play in cubital tunnel surgery.Level of evidence: III

Keywords:

nerve wrap , Ulnar nerve , cubital tunnel syndrome , Amnion , human amniotic membrane