Open and endoscopic decompression for cubital tunnel syndrome: long-term clinical outcomes, prognostic factors, and comparison of anterior transposition techniques

The optimal surgical treatment for cubital tunnel syndrome (CuTS) remains controversial, and comparative evidence regarding endoscopic-assisted anterior transposition is lacking. This study compared the clinical and functional outcomes of open and endoscopic decompression, evaluated open versus endoscopic-assisted anterior transposition, and identified patient-related prognostic factors associated with postoperative outcomes. Fifty-six patients who underwent surgery for CuTS between 2010 and 2023 were retrospectively reviewed. Nineteen patients underwent open in situ decompression and 37 underwent endoscopic decompression. Outcomes were assessed using Quick DASH, VAS, Wilson–Krout grading system, patient satisfaction, and job change. An additional comparative analysis was performed in patients requiring anterior transposition because of intraoperative ulnar nerve instability (open, n = 16; endoscopic-assisted, n = 11). Smoking, body mass index (BMI), occupation, and preoperative McGowan grade were evaluated as prognostic factors. Median follow-up was 138 months (range, 56–180) in the open group and 76 months (range, 27–156) in the endoscopic group. No statistically significant differences were detected between open and endoscopic decompression in postoperative Quick DASH, VAS, Wilson–Krout grades, patient satisfaction, job change, or complication rates. Among patients undergoing anterior transposition, median follow-up was 148 months (range, 60–180) after open transposition and 105 months (range, 50–156) after endoscopic-assisted transposition. No statistically significant differences were detected in postoperative Quick DASH, VAS or Wilson–Krout grades between patients who underwent open anterior transposition and those who underwent endoscopic-assisted anterior transposition. Increasing preoperative McGowan grade was associated with worse postoperative Quick DASH, VAS, and Wilson–Krout outcomes. Smoking and higher BMI were associated with less favorable Wilson–Krout outcomes, whereas occupation had no significant effect on postoperative recovery. No statistically significant differences were detected in long-term clinical and functional outcomes between open and endoscopic decompression for CuTS. Similarly, no statistically significant differences were detected between open and endoscopic-assisted anterior transposition. Greater preoperative disease severity was associated with less favorable postoperative outcomes. Given the retrospective design and limited sample size, these findings should not be interpreted as evidence of equivalence or non-inferiority between the surgical techniques.