Background: Tendon transfer is a key surgical technique for restoring hand and wrist function in radial nerve palsy, particularly when nerve recovery is unlikely. However, the optimal timing for surgery remains debated. This meta-analysis evaluates the impact of early (12 months) tendon transfer on motor recovery, wrist function, and revision rates. Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library identified seven studies. Statistical analysis was performed using Review Manager 5.4.1 and R Studio. A random-effects model was applied to calculate risk ratios (RR) and proportions with 95% confidence intervals (CI). Heterogeneity was assessed using I², and risk of bias was evaluated with ROBINS-I. Results: Early tendon transfer significantly improved complete motor recovery (RR = 2.40, 95% CI: 1.26–4.55, P = 0.008), with low-to-moderate heterogeneity (I² = 29%). Wrist flexion limitation showed no significant difference between early and late surgery (RR = 1.23, 95% CI: 0.50–3.01, P = 0.66, I² = 34%). Functional outcomes measured by DASH scores showed no statistically significant difference between tendon transfer and non-tendon transfer approaches (Mean Difference = -2.92, 95% CI: -12.65 to 6.82, P = 0.56, I² = 0%), though a trend toward improved function with tendon transfer was observed. Revision surgery occurred in 20% of cases (95% CI: 4%–37%), with low heterogeneity (I² = 0%). Conclusions: Early tendon transfer significantly improves motor recovery, supporting its role as the preferred approach. However, timing does not affect wrist flexion limitation, suggesting that rehabilitation protocols influence outcomes. The 20% revision rate highlights the need for careful patient selection and surgical planning. Future studies should explore snerve transfers, regenerative medicine, and long-term functional outcomes. Keywords: Radial nerve palsy, tendon transfer, early surgery, motor recovery, revision surgery, meta-analysis
Mardana et al. (2025) studied this question.