A Systematic Review of Retrospective Evidence on Patient and Surgical Factors in Recurrent Cubital Tunnel Syndrome.
Bibliographic record
Abstract
Objectives: There is much debate regarding which patient-related risk factors and surgical techniques contribute to recurrent cubital tunnel syndrome (CuTS). This systematic review aimed to identify preoperative risk factors and surgical techniques associated with symptom recurrence or revision surgery following cubital tunnel release. Methods: We searched PubMed, Scopus, Cochrane Library, and clinicaltrials.gov databases for potentially eligible articles published between January 2009 and November 2024. Using Covidence, four reviewers screened based on predefined inclusion criteria: studies examining recurrent CuTS following surgery, reporting patient characteristics and/or surgical techniques, and published in English. A standardized Excel sheet was utilized to extract patient demographics, recurrence rates, and revision outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity in outcomes, no formal metaanalysis was performed, and a narrative synthesis was done. Results: Fourteen studies were included, totaling 49,492 patients with idiopathic CuTS treated with ulnar nerve surgery. Revision rates ranged 1.2-23.8%. Younger age was described as a risk factor in ten studies, although one study identified older age as a predictive risk factor. In contrast, another study described it as a protective factor. Diabetes was associated with recurrence risk in two studies, while sex, BMI, and smoking showed inconsistent associations. Severe preoperative symptoms or higher McGowan scores were associated with poorer outcomes in two studies. Overall, recurrence and revision rates were low across all techniques. Conclusion: The retrospective nature and limited power of included studies increase risk of selection and Type II errors. Regardless, there seems to be no significant difference in recurrence/revision rates based on surgical techniques. CuTR was often recommended as an initial procedure while ulnar nerve transposition (UNT) was reserved for revisions or patients with nerve subluxation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.104 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.009 | 0.011 |
| Bibliometrics | 0.016 | 0.015 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".