Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands

Abstract

We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8 degrees (range, 0-45) and the mean visual analogue satisfaction scale was 74 (range, 10-100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient's satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.

The prevalence of the extensor indicis tendon and its variants: a systematic review and meta-analysis

“…It is also the commonest tendon transfer to restore thumb extension after loss of EPL function [30]. In addition, the EIP tendon offers surgical possibilities to treat ulnar deviation of the fingers and tendon ruptures in patients with rheumatoid arthritis [9,11,27]. During an EI transfer to EPL, a careful identification of an existing EPI is crucial otherwise a separate extension of the thumb will be impossible [14].…”

Soft Tissue Reconstructive Procedures in the Rheumatoid Wrist, Including Tendon Transfer Procedures

“…Patient satisfaction is correlated with the MP joint extension lag but not with pulp-topalm distance [ 28 ].…”

Tendon Transfers in the Rheumatoid Hand for Reconstruction

“…One retrospective review comparing 11 cases of tendon transfer with 28 cases of tendon grafting noted no significant difference in clinical results. 5 Further study is required to better define the role of tendon grafting in the treatment of patients with rheumatoid arthritis.…”

“…Tendon rupture is a late complication of the disease often presenting a decade or later after diagnosis. 5 Given that medical treatment has been shown to reduce disease activity and that the rates of radiographic rheumatoid arthritis severity were similar between groups in this study, the initiation of medical treatment of the patients in this series likely occurred too late in the disease process to affect the incidence of tendon rupture. With the advances in the medical management of these patients, the incidence of tendon rupture may significantly decrease in the future.…”

“…These ruptures frequently go unnoticed for some time because of the patients' baseline functional limitations, causing a delayed presentation for medical evaluation. [5][6][7][8] Diagnosis of a tendon rupture in a rheumatoid population requires a thorough history and physical examination. Preexisting deformity and concomitant disorders, including limitations in joint range of motion, can make the diagnosis a challenge.…”