{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:14:44Z","timestamp":1779358484940,"version":"3.51.4"},"reference-count":51,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Carpal tunnel syndrome (CTS) is the most prevalent peripheral nerve entrapment neuropathy, with rising incidence in aging populations. Uncertainty persists regarding the efficacy and safety of carpal tunnel release (CTR) in patients aged \u2265 70 years. Objectives: To systematically evaluate the indications, clinical outcomes, and utility of CTR in elderly patients (\u226570 years), with comparison to younger cohorts. Methods: Following PRISMA 2020 guidelines, PubMed\/MEDLINE, Scopus, CENTRAL, Embase, Web of Science, and grey literature sources were searched from inception through September 2025. Two independent reviewers extracted data; inter-rater agreement was strong (\u03ba = 0.81\u20130.86). The primary outcome was the Boston Carpal Tunnel Questionnaire (BCTQ). Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using DerSimonian\u2013Laird random-effects models. Certainty of evidence was assessed using the GRADE framework. Results: A total of 20 studies encompassing 3841 operated hands, including 1139 hands in elderly patients and 2702 hands in younger comparators across comparative studies, were analyzed. Mean SS-BCTQ improvement was 1.8 points (95%CI: 1.6\u20132.0; exceeding the established MCID of 1.04\u20131.05 points). FS-BCTQ improvement was 1.1 points (95%CI: 0.9\u20131.3; marginally below the pooled MCID of 1.13 points). Elderly patients demonstrated SS-BCTQ improvement of 1.7 points and satisfaction rates of 72\u201394%, comparable to younger cohorts (75\u201395%; p = 0.38). Grip strength improved 15\u201325% in younger patients but remained unchanged in elderly patients (p &lt; 0.001). Sensory recovery reached 42% in elderly versus 58% in younger patients (p &lt; 0.01). Complication rates were low and age-independent (3.1%; RR 1.08; 95%CI: 0.86\u20131.35; p = 0.52). GRADE certainty was as follows: low for symptom and functional improvement; very low for surgery versus conservative management. Conclusions: CTR is associated with significant symptomatic benefit in elderly patients when conservative treatment fails, with complication rates comparable to younger populations. Age alone should not constitute a surgical contraindication. Preoperative counseling must establish realistic expectations regarding grip strength and functional recovery. High-quality randomized trials in elderly populations remain an urgent research priority.<\/jats:p>","DOI":"10.3390\/medsci14020264","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:12:54Z","timestamp":1779286374000},"page":"264","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Carpal Tunnel Release in Patients Aged 70 Years and Older: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Elisa","family":"Di Dio","sequence":"first","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3003-2391","authenticated-orcid":false,"given":"Giulia Maria","family":"Sassara","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8163-562X","authenticated-orcid":false,"given":"Adriano","family":"Cannella","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Ianniccari","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, CTO Hospital, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Delia","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University Hospital of Messina \u201cAOU Gaetano Martino\u201d, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-0950","authenticated-orcid":false,"given":"Vitale","family":"Cilli","sequence":"additional","affiliation":[{"name":"Department of Chirurgie de la Main, Centre Hospitalier Interregional Edith Cavell, 1160 Bruxelles, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Valerio","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4184-0884","authenticated-orcid":false,"given":"Giulia","family":"Frittella","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9983-3800","authenticated-orcid":false,"given":"Lorenzo","family":"Rocchi","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9714-1285","authenticated-orcid":false,"given":"Rocco","family":"De Vitis","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.jhsa.2009.11.003","article-title":"Carpal tunnel syndrome","volume":"35","author":"Bickel","year":"2010","journal-title":"J. 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