Extensor-tendons reconstruction using autogenous palmaris longus tendon grafting for rheumatoid arthritis patients

Abstract

BackgroundThe purpose of the study is to retrospectively review the clinical outcome of our study population of middle-aged RA patients who had suffered extensor-tendon rupture. We reported the outcome of autogenous palmaris tendon grafting of multiple extensor tendons at wrist level in 14 middle-aged rheumatoid patients.MethodsBetween Feb. 2000 to Feb. 2004, thirty-six ruptured wrist level extensor tendons were reconstructed in fourteen rheumatoid patients (11 women and three men) using autogenous palmaris longus tendon as a free interposition graft. In each case, the evaluation was based on both subjective and objective criteria, including the range of MCP joint flexion after surgery, the extension lag at the metacarpophalangeal joint before and after surgery, and the ability of the patient to work.Results and DiscussionThe average of follow-up was 54.1 months (range, 40 to 72 months). The average range of MCP joint flexion after reconstruction was 66°. The extension lag at the metacarpophalangeal joint significantly improved from a preoperative mean of 38° (range, 25°–60°) to a postoperative mean of 16° (range, 0°–30°). Subjectively all patients were satisfied with the clinical results, and achieved a return to their level of ability before tendon rupture. We found good functional results in our series of interposition grafting using palmaris longus to reconstruct extensor tendon defects in the rheumatoid patients.ConclusionReconstruction for multiple tendon ruptures is a salvage procedure that is often associated with extensor lag and impairment of overall function. Early aggressive treatment of extensor tendon reconstruction using autogenous palmaris longus tendon as a free interposition graft in the rheumatoid wrist is another viable option to achieve good clinical functional result.

The palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis

“…It has been used in the reconstruction of other tendons (Mountney et al, 1998;Lin et al, 2004;Unglaub et al, 2006;Chu et al, 2008), for frontalis suspension in the treatment of blepharoptosis (Kurihara et al, 1984;Lam et al, 1996;Park and Shin, 2008), as a substitute for ligaments in the stabilization of joints (Jackson and Saint Onge, 1977;Scheker and Ozer, 2004;Furukawa et al, 2007) or of the digital pulleys (Kaufmann and Pacek, 2006), and for the reconstruction of lip (Gürlek et al, 2005;Cinar et al, 2007) and eyelid defects (Ueda et al, 2007). The palmaris longus tendon is also used as a topographical landmark for surgery in the wrist area (Brones and Wilgis, 1978) and the muscle should be considered as a possible cause of ulnar or median nerve compression syndromes (Tiengo et al, 2006) or of forearm pseudo-masses when hypertrophied (Polesuk and Helms, 1998).…”

Tendon Transfers in the Rheumatoid Hand for Reconstruction

“…Meanwhile, others have shown good functional results and improved biomechanical properties using tendon grafting for the repair of extensor tendon ruptures in this patient population. 13,14 Comparative studies between tendon grafting and tendon transfer for the repair of extensor tendon ruptures in rheumatoid patients are lacking in the literature. One retrospective review comparing 11 cases of tendon transfer with 28 cases of tendon grafting noted no significant difference in clinical results.…”

“…Palmaris longus Strips of extensor carpi radialis brevis or extensor carpi radialis longus (ECRL) Plantaris Extensor tendon to the fourth toe 8,10,13,14 …”

Extensor tendon gap reconstruction: a review

“…If possible, interpositional tendon grafting technique using the PL tendon to reconstruct the extensor tendon would be preferable for rheumatoid arthritis patients. As described by Chu et al [17], the tendon is sutured using Pulvertaft technique, allowing for early rehabilitation, and the repair is made in 30 wrist extension ( Figure 6). MP and IP joints are in neutral position and the wrist is immobilized in 30 extension.…”