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

Document Type : RESEARCH PAPER

Authors

1 1 Kaiser Permanente Southern California, Baldwin Park, CA, USA 2 USC Keck School of Medicine, Los Angeles, CA, USA

2 USC Keck School of Medicine, Los Angeles, CA, USA

3 Kaiser Permanente Southern California, Pasadena, CA

4 Kaiser Permanente Southern California, Baldwin Park, CA, USA

5 Kaiser Permanente Southern California, Anaheim, CA, USA

Abstract

Background: Compare the recurrence rate of paresthesias in patients undergoing primary cubital tunnel surgery in
those 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 minimum
90-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 experienced
initial complete resolution of symptoms (paresthesias) but then developed recurrence of paresthesias.
Results: A total of 57 controls (CON) and 21 treated with HAM met our inclusion criteria. There was a difference in
the mean age of CON (48.4 ± 13.5 years) and HAM (30.6 ± 15) (P< 0.0001). There was no difference in gender mix
(P=0.4), the severity of symptoms (P=0.13), and length of follow-up (P=0.084). None of 21 (0%) treated with HAM
developed recurrence of symptoms compared to 11 of 57 (19.3%) (P=0.03) (CON). Using a multivariate regression
model adjusted for age and procedure type, CON was 24.4 (95% CI=1.26-500, P=0.0348) times higher risk than HAM
of developing a recurrence of symptoms.
Conclusion: The HAM wrapping used in primary cubital tunnel surgery significantly reduced recurrence rates of
paresthesias. Further prospective studies with randomization should be carried out to better understand the role HAM
can play in cubital tunnel surgery.
Level of evidence: III

Keywords

References

  1. Palmer BA, Hughes TB. Cubital tunnel syndrome. J Hand Surg Am. 2010;35(1):153-63. doi: 10.1016/j.jhsa.2009.11.004.
  2. Camp CL, Ryan CB, Degen RM, Dines JS, Altchek DW, Werner BC. Risk factors for revision surgery following isolated ulnar nerve release at the cubital tunnel: a study of 25,977 cases. J Shoulder Elbow Surg. 2017;26(4):710-5. doi: 10.1016/j.jse.2016.10.028.
  3. Staples JR, Calfee R. Cubital Tunnel Syndrome: Current Concepts. J Am Acad Orthop Surg. 2017; 25(10):e215-e24. doi: 10.5435/JAAOS-D-15-00261.
  4. Shi Q, MacDermid JC, Santaguida PL, Kyu HH. Predictors of surgical outcomes following anterior transposition of ulnar nerve for cubital tunnel syndrome: a systematic review. J Hand Surg Am. 2011;36(12):1996-2001 e1-6. doi: 10.1016/j.jhsa.2011.09.024.
  5. Nellans K, Tang P. Evaluation and treatment of failed ulnar nerve release at the elbow. Orthop Clin North Am. 2012;43(4):487-94. doi: 10.1016/j.ocl.2012.07.018.
  6. Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89(12):2591-8. doi: 10.2106/JBJS.G.00183.
  7. Gaspar MP, Kane PM, Putthiwara D, Jacoby SM, Osterman AL. Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome. J Hand Surg Am. 2016;41(3):427-35. doi: 10.1016/j.jhsa.2015.12.012.
  8. Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ. Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the national survey of ambulatory surgery database. J Hand Surg Am. 2013;38(8):1551-6. doi: 10.1016/j.jhsa.2013.04.044.
  9. Aleem AW, Krogue JD, Calfee RP. Outcomes of revision surgery for cubital tunnel syndrome. J Hand Surg Am. 2014;39(11):2141-9. doi: 10.1016/j.jhsa.2014.07.013.
  10. Krogue JD, Aleem AW, Osei DA, Goldfarb CA, Calfee RP. Predictors of surgical revision after in situ decompression of the ulnar nerve. J Shoulder Elbow Surg. 2015;24(4):634-9. doi: 10.1016/j.jse.2014.12.015.
  11. Tsai TM, Bonczar M, Tsuruta T, Syed SA. A new operative technique: cubital tunnel decompression with endoscopic assistance. Hand Clin. 1995; 11(1):71-80.
  12. Tsai TM, Tsuruta T, Syed SA, Kimura H. A new technique for endoscopic carpal tunnel decompression. J Hand Surg Br. 1995;20(4):465-9. doi: 10.1016/s0266-7681(05)80154-8.
  13. King T, Morgan FP. Late results of removing the medial humeral epicondyle for traumatic ulnar neuritis. J Bone Joint Surg Br. 1959;41-B(1):51-5. doi: 10.1302/0301-620X.41B1.51.
  14. Filippi R, Charalampaki P, Reisch R, Koch D, Grunert P. Recurrent cubital tunnel syndrome. Etiology and treatment. Minim Invasive Neurosurg. 2001;44(4):197-201. doi: 10.1055/s-2001-19937.
  15. Gabel GT, Amadio PC. Reoperation for failed decompression of the ulnar nerve in the region of the elbow. J Bone Joint Surg Am. 1990;72(2):213-9.
  16. Rogers MR, Bergfield TG, Aulicino PL. The failed ulnar nerve transposition. Etiology and treatment. Clin Orthop Relat Res. 1991(269):193-200.
  17. Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg. 2014;67(5):662-75. doi: 10.1016/j.bjps.2014.01.031.
  18. Heckmann N, Auran R, Mirzayan R. Application of Amniotic Tissue in Orthopedic Surgery. Am J Orthop (Belle Mead NJ). 2016;45(7):E421-e5.
  19. Ferguson MW, O’Kane S. Scar-free healing: from embryonic mechanisms to adult therapeutic intervention. Philos Trans R Soc Lond B Biol Sci. 2004;359(1445):839-50. doi: 10.1098/rstb.2004.1475.
  20. Mirzayan R, Syed SP, Shean CJ. Dissection of an Ulnar Nerve Previously Transposed and Wrapped with Human Amniotic Membrane: A Report of 3 Cases. JBJS Case Connect. 2021;11(3). doi: 10.2106/JBJS.CC.21.00066.
  21. Kim SS, Sohn SK, Lee KY, Lee MJ, Roh MS, Kim CH. Use of human amniotic membrane wrap in reducing perineural adhesions in a rabbit model of ulnar nerve neurorrhaphy. J Hand Surg Eur Vol. 2010;35(3):214-9. doi: 10.1177/1753193409352410.
  22. Gaspar MP, Abdelfattah HM, Welch IW, Vosbikian MM, Kane PM, Rekant MS. Recurrent cubital tunnel syndrome treated with revision neurolysis and amniotic membrane nerve wrapping. J Shoulder Elbow Surg. 2016;25(12):2057-65. doi: 10.1016/j.jse.2016.09.013.
  23. McGowan A. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. 1950;32-B(3):293-301. doi: 10.1302/0301-620X.32B3.293.
  24. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77(2):263-5. doi: 10.1136/jnnp.2005.066696.
  25. Bartels RH, Verhagen WI, van der Wilt GJ, Meulstee J, van Rossum LG, Grotenhuis JA. Prospective randomized controlled study comparing simple decompression versus anterior subcutaneous transposition for idiopathic neuropathy of the ulnar nerve at the elbow: Part 1. Neurosurgery. 2005;56(3):522-30; discussion -30. doi: 10.1227/01.neu.0000154131.01167.03.
  26. Biggs M, Curtis JA. Randomized, prospective study comparing ulnar neurolysis in situ with submuscular Neurosurgery. 2006;58(2):296-304; discussion 296-304. doi: 10.1227/01.NEU. 0000194847.04143.A1.
  27. Gervasio O, Gambardella G, Zaccone C, Branca D. Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study. Neurosurgery. 2005;56(1):108-17; discussion 17. doi: 10.1227/01.neu.0000145854.38234.81.
  28. Nabhan A, Ahlhelm F, Kelm J, Reith W, Schwerdtfeger K, Steudel WI. Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Br. 2005;30(5):521-4. doi: 10.1016/j.jhsb.2005.05.011.
  29. Catalano LW, 3rd, Barron OA. Anterior subcu-taneous transposition of the ulnar nerve. Hand Clin. 2007;23(3):339-44, vi. doi: 10.1016/j.hcl. 2007.06.005.
  30. Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am. 2008;33(8):1314 e1-12. doi: 10.1016/j.jhsa.2008.03.006.
  31. Zhang D, Earp BE, Blazar P. Rates of Complications and Secondary Surgeries After In Situ Cubital Tunnel Release Compared With Ulnar Nerve Transposition: A Retrospective Review. J Hand Surg Am. 2017;42(4):294 e1- e5. doi: 10.1016/j.jhsa.2017.01.020.
  32. Hutchinson DT, Sullivan R, Sinclair MK. Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression. Hand (N Y). 2021;16(4):447-452. doi: 10.1177/1558944719873153.
  33. Mackinnon SE, Novak CB. Operative findings in reoperation of patients with cubital tunnel syndrome. Hand (N Y). 2007;2(3):137-43. doi: 10.1007/s11552-007-9037-3.
  34. Tanaka SK, Lourie GM. Anatomic course of the medial antebrachial cutaneous nerve: a cadaveric study with proposed clinical application in failed cubital tunnel release. J Hand Surg Eur Vol. 2015;40(2):210-2. doi: 10.1177/1753193413515826.
  35. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002;18(2):231-41. doi: 10.1016/s0749-0712(01)00012-9.
  36. Tang DT, Barbour JR, Davidge KM, Yee A, Mackinnon SE. Nerve entrapment: update. Plast Reconstr Surg. 2015;135(1):199e-215e. doi: 10.1097/PRS. 0000000000000828.
  37. Abe Y, Doi K, Kawai S. An experimental model of peripheral nerve adhesion in rabbits. Br J Plast Surg. 2005;58(4):533-40. doi: 10.1016/j.bjps.2004.05.012.
  38. Kokkalis ZT, Jain S, Sotereanos DG. Vein wrapping at cubital tunnel for ulnar nerve problems. J Shoulder Elbow Surg. 2010;19(2 Suppl):91-7. doi: 10.1016/j.jse.2009.12.019.
  39. Danoff JR, Lombardi JM, Rosenwasser MP. Use of a pedicled adipose flap as a sling for anterior subcutaneous transposition of the ulnar nerve. J Hand Surg Am. 2014;39(3):552-5. doi: 10.1016/j.jhsa.2013.12.005.
  40. Ulivieri S, Pluchino MG, Petrini C, Giorgio A, Oliveri G. Protective wrapping of the ulnar nerve in severe cubital tunnel syndrome: treatment and long-term results. G Chir. 2010;31(10):459-61.
  41. Puckett BN, Gaston RG, Lourie GM. A novel technique for the treatment of recurrent cubital tunnel syndrome: ulnar nerve wrapping with a tissue engineered bioscaffold. J Hand Surg Eur Vol. 2011;36(2):130-4. doi: 10.1177/1753193410384690.
  42. Papatheodorou LK, Williams BG, Sotereanos DG. Preliminary results of recurrent cubital tunnel syndrome treated with neurolysis and porcine extracellular matrix nerve wrap. J Hand Surg Am. 2015;40(5):987-92. doi: 10.1016/j.jhsa.2015.02.031.
  43. Soltani AM, Allan BJ, Best MJ, Mir HS, Panthaki ZJ. Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity. Ann Plast Surg. 2014;72(5):572-8. doi: 10.1097/SAP.0b013e3182956475.
  44. Tosi GM, Massaro-Giordano M, Caporossi A, Toti P. Amniotic membrane transplantation in ocular surface disorders. J Cell Physiol. 2005;202(3):849-51. doi: 10.1002/jcp.20181.
  45. Sippel KC, Ma JJ, Foster CS. Amniotic membrane surgery. Curr Opin Ophthalmol. 2001;12(4):269-81. doi: 10.1097/00055735-200108000-00006.
  46. Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J. 2009;18(8):1202-12. doi: 10.1007/s00586-009-1013-x.
  47. Niknejad H, Peirovi H, Jorjani M, Ahmadiani A, Ghanavi J, Seifalian AM. Properties of the amniotic membrane for potential use in tissue engineering. Eur Cell Mater. 2008;15:88-99. doi: 10.22203/ecm.v015a07.
  48. Lee SB, Li DQ, Tan DT, Meller DC, Tseng SC. Suppression of TGF-beta signaling in both normal conjunctival fibroblasts and pterygial body fibroblasts by amniotic membrane. Curr Eye Res. 2000;20(4):325-34.
  49. Tseng SC, Li DQ, Ma X. Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix. J Cell Physiol. 1999;179(3):325-35. doi: 10.1002/(SICI)1097-4652(199906)179:3<325::AID-JCP10>3.0.CO;2-X.
  50. Meng H, Li M, You F, Du J, Luo Z. Assessment of processed human amniotic membrane as a protective barrier in rat model of sciatic nerve injury. Neurosci Lett. 2011;496(1):48-53. doi: 10.1016/j.neulet.2011.03.090.
  51. Ozgenel GY, Filiz G. Combined application of human amniotic membrane wrapping and hyaluronic acid injection in epineurectomized rat sciatic nerve. J Reconstr Microsurg. 2004;20(2):153-7. doi: 10.1055/s-2004-820772.
  52. Patel VR, Samavedi S, Bates AS, et al. Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score-matched Analysis. Eur Urol. 2015;67(6):977-80. doi: 10.1016/j.eururo. 2015.01.012.
  53. Subach BR, Copay AG. The use of a dehydrated amnion/chorion membrane allograft in patients who subsequently undergo reexploration after posterior lumbar instrumentation. Adv Orthop. 2015;2015:501202. doi: 10.1155/2015/501202.
  54. Cargnoni A, Ressel L, Rossi D, et al. Conditioned medium from amniotic mesenchymal tissue cells reduces progression of bleomycin-induced lung fibrosis. Cytotherapy. 2012;14(2):153-61. doi: 10.3109/14653249.2011.613930.
  55. Ashworth MF, Morton KE, Dewhurst J, Lilford RJ, Bates RG. Vaginoplasty using amnion. Obstet Gynecol. 1986;67(3):443-6.
  56. Tancer ML, Katz M, Veridiano NP. Vaginal epithelialization with human amnion. Obstet Gynecol. 1979;54(3):345-9.
  57. Kamiya K, Wang M, Uchida S, et al. Topical application of culture supernatant from human amniotic epithelial cells suppresses inflammatory reactions in cornea. Exp Eye Res. 2005;80(5):671-9. doi: 10.1016/j.exer.2004.11.018.
  58. Vines JB, Aliprantis AO, Gomoll AH, Farr J. Cryopreserved Amniotic Suspension for the Treatment of Knee Osteoarthritis. J Knee Surg. 2016;29(6):443-50. doi: 10.1055/s-0035-1569481.
  59. Zelen CM, Poka A, Andrews J. Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis--a feasibility study. Foot Ankle Int. 2013;34(10):1332-9. doi: 10.1177/1071100713502179.
  60. Hanselman AE, Tidwell JE, Santrock RD. Cryopreserved human amniotic membrane injection for plantar fasciitis: a randomized, controlled, double-blind pilot study. Foot Ankle Int. 2015;36(2):151-8. doi: 10.1177/1071100714552824.
  61. DeMill SL, Granata JD, McAlister JE, Berlet GC, Hyer CF. Safety analysis of cryopreserved amniotic membrane/umbilical cord tissue in foot and ankle surgery: a consecutive case series of 124 patients. Surg Technol Int. 2014;25:257-61.
  62. Warner M, Lasyone L. An Open-label, Single-center, Retrospective Study of Cryopreserved Amniotic Membrane and Umbilical Cord Tissue as an Adjunct for Foot and Ankle Surgery. Surg Technol Int. 2014;25:251-5.
The Archives of Bone and Joint Surgery
Volume 10, Issue 11
November 2022
Pages 969-975

Files

History

  • Receive Date: 06 October 2021
  • Revise Date: 27 November 2021
  • Accept Date: 13 December 2021
  • First Publish Date: 17 October 2022

Share

How to cite

Statistics