Comparative effectiveness of open versus percutaneous release for trigger fingers: A systematic review and meta-analysis of randomized controlled trials.

Abstract

The relative safety and effectiveness of percutaneous versus open A1 pulley release for trigger finger remain unclear. This systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) compares these two techniques and evaluates the potential benefits of ultrasound guidance in percutaneous release. Following PRISMA guidelines, this SR and MA was conducted of RCTs published up to August 11, 2025. PubMed, Embase, and Cochrane Library were searched to identify studies comparing percutaneous release with open surgery for trigger finger. Outcomes assessed included function, pain, complications, and revision rates at immediate (1 week), short-term (<1 month), mid-term (3 months), and long-term (6 months) follow-up. Subgroup analysis examined ultrasound-guided versus non-ultrasound-guided percutaneous release. Fourteen RCTs involving 996 patients were included. Percutaneous release demonstrated significantly better outcomes in immediate (mean difference (MD): 24.94, 95 % CI: 11.82-38.06), short-term (MD: 15.08, 95 % CI: 10.25-19.92), and mid-term (MD: 7.27, 95 % CI: 2.36-12.19) Q-DASH scores, as well as time to return to work (MD: 12.82 days, 95 % CI: 10.00-15.63), and duration of postoperative analgesic use (MD: 4.66 days, 95 % CI: 1.77-7.55) (all p < 0.05). No significant differences were observed in long-term outcomes, including DASH scores, grip strength, motion, immediate and mid-term VAS, complications, or revision rates. Both percutaneous release and open surgery are effective treatments for trigger finger. Percutaneous release provides faster functional recovery, earlier return to daily activities, and reduced analgesic use, while maintaining comparable safety to open surgery.