Work

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

Year: 2025

Type: article

Abstract: 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.

Source: The Journal Of Hand Surgery

DOI: 10.1016/j.jhsa.2025.08.018