Reconstruction of the flexor retinaculum: anatomical basis in carpal tunnel syndrome

The goal of this anatomical study is to prove that reconstruction of the flexor retinaculum in carpal tunnel syndrome surgery is a reliable procedure and can improve the results of this procedure. In the first static study, we noted that when left to heal spontaneously, after 3 months the gap between the two edges of the cut retinaculum remained equal to or even larger than the gap created at the time of the surgery. A special Canaletto™® implant was created to achieve this reconstruction. It is technically possible to do this reconstruction by a 2 to 3 cm surgical approach in the palm. In another, dynamic study, we used a transducer to analyse the forces borne by the retinaculum during flexor tendon contraction. We compared these forces in a normal retinaculum, a reconstructed retinaculum with the Canaletto™® implant and a retinaculum opened endoscopically. This reconstruction conserves the anterior continuity of the retinaculum, allows excellent carpal tunnel decompression and immediately permits near-physiological forces. We discuss the advantages and the limits of this reconstruction. We think that this new surgical technique in the Carpal Tunnel Syndrome (CTS) will be able to improve the results, particularly in recurrences, in wrist malunion with CTS, in cases with severe electromyographic change with a sensory conduction speed of under 15 m.s–1 and in metabolic CTS. As always, his implant needs to be evaluated through a mid and long term clinical follow-up. By recovering better grip strength and reducing postoperative pain, this surgical technique can decrease the time needed to return to work and hence the economic costs of CTS surgery. [Copyright &y& Elsevier]