A Novel Grooved MacDonald Dissector Used in Arthroscopic Carpal Tunnel Release

Abstract Background: Arthroscopic carpal tunnel release (ACTR) offers faster recovery and improved cosmetic outcomes compared to open techniques, but the use of specialized and expensive instrumentation may increase procedural cost and risk of iatrogenic median nerve injury.We described a novel modification of the MacDonald Dissector with a groove at its straight blunt blade and evaluate its utility in ACTR as a cost-effective and safer alternative. Methods: A standard MacDonald Dissector was modified by incorporating a longitudinal groove on the straight blunt blade. During ACTR, the grooved surface was positioned between the transverse carpal ligament (TCL) and the median nerve, allowing controlled ligament division under arthroscopic visualization while protecting the nerve. Results: The modified instrument facilitated safe TCL release with minimal incision (2 cm), reduced operative complexity, and no observed cases of median nerve injury, scar tenderness, or wound complications during follow-up. Patients demonstrated reduced postoperative pain and improved grip and pinch strength. Conclusion: The novel grooved MacDonald Dissector provides a simple, economical, and effective alternative for ACTR. It enhances nerve protection while maintaining the benefits of minimally invasive release, potentially reducing complication rates associated with complex endoscopic systems.