Ligament lengthening compared with simple division of the transverse carpal ligament in the open treatment of carpal tunnel syndrome.

It has been suggested that the new (and controversial) endoscopic techniques are more successful than standard operation for the preservation of the ligamentous pulley function across the carpal tunnel and for the separation of the gliding structures from the subcutaneous tissues after release of the carpal ligament in carpal tunnel syndrome. We therefore decided to study the possible importance of preserving the continuity of the carpal ligament by doing an open lengthening of the ligament. This retrospective, unrandomised study included 99 patients with carpal tunnel syndrome who underwent open release of the carpal tunnel with or without a simultaneous lengthening of the transverse carpal ligament. The duration of follow up ranged from 4-8 years. The group who had the ligament lengthened had significantly longer sick leave (p < 0.01) than the group who had transverse ligament section alone. There were no advantages to reconstruction of the transverse ligament.