Revision anterior submuscular transposition of the ulnar nerve for failed subcutaneous transposition.

We evaluated the results of revision surgery for persistent cubital tunnel syndrome after failed surgical treatment. Eighteen patients were evaluated with an average age of 44 years. The majority of the primary procedures were subcutaneous transpositions (15 patients). The average follow-up time was 34 months. All patients were treated with a submuscular transposition of the ulnar nerve and Z-lengthening of the flexor-pronator origin. The most common operative findings were perineural scarring (16), retained medial intermuscular septum (10) and common flexor aponeurosis (9). Pre-operative and post-operative data were compared. The majority of patients improved their postoperative grade and their ability to do daily activities or work and stated that the surgery met some or all of their expectations. Most patients had partial relief of their pain and the satisfaction rate was 78%. Our study suggests that although these results are less favorable than those for the primary procedure, submuscular transposition is a useful technique for revision of failed cubital tunnel syndrome surgery.