ArticleJournal of hand surgery global online2026
Supercharged End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer: A Systematic Review and Meta-analysis.
Article in Journal of hand surgery global online, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Ulnar nerve (UN) injuries frequently result in intrinsic hand muscle weakness and functional impairment, particularly in high-level lesions where prolonged axonal regeneration limits recovery. The supercharged end-to-side (SETS) anterior interosseous nerve (AIN)-to-ulnar motor nerve transfer was developed to enhance distal reinnervation and preserve intrinsic motor endplates. This study aimed to evaluate outcomes following SETS AIN-to-ulnar motor nerve transfer for UN pathology. Methods: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. MEDLINE, PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Studies reporting postoperative outcomes following SETS transfer for UN pathology were included. A random-effects meta-analysis was performed for binary outcomes. Results: Sixteen studies comprising 447 patients met the inclusion criteria. The pooled rate of intrinsic muscle recovery, defined as Medical Research Council (MRC) grade ≥ 3, was 80.6%. Recovery to near-normal strength (MRC ≥ 4) was achieved in 64.4%. Subgroup analysis demonstrated a notably higher MRC ≥ 4 recovery rate in traumatic injuries (85.5%) compared with compressive (52.9%) or mixed pathologies (33.3%). Surgical intervention within 12 months was associated with notably improved MRC ≥ 3 recovery. Functional outcomes improved, with mean grip strength reaching 75.7% of the contralateral side. Residual clinical signs persisted, including Froment's sign (17.6%), ulnar clawing (12.1%), and Wartenberg's sign (59.1%). The overall complication rate was 7.9%. Conclusions: SETS AIN-to-ulnar motor nerve transfer is a safe and effective adjunct for high UN pathology, particularly when performed early. Traumatic injuries demonstrate the highest rates of near-normal intrinsic recovery, although residual clinical signs may persist. Type of study/level of evidence: Therapeutic III.
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