Wide-Awake Flexor Pollicis Longus Tendon Reconstruction with Evaluation of the Active Voluntary Contraction of the Ruptured Muscle-Tendon

Abstract

Summary: The purpose of this study was to investigate the clinical outcome of the wide-awake tendon reconstruction for chronic rupture of the flexor pollicis longus tendon with evaluation of the voluntary active contraction distance of the ruptured musculotendinous unit. Eleven consecutive patients underwent tendon reconstruction under wide-awake surgery. If the total of the passive distraction distance and the active contraction distance of the ruptured flexor pollicis longus musculotendinous unit was greater than 30 mm, tendon grafting was performed. If not, tendon transfer was performed using the fourth flexor digitorum superficialis. Patients were evaluated with total active motion before surgery, during surgery, and in final follow-up and subjectively surveyed with quick Disabilities of the Arm, Shoulder and Hand scores. The final outcomes of tendon grafting and of tendon transfer were compared. Tendon grafting was performed in four patients, and tendon transfer was performed in seven patients. The final follow-up total active motion was 84.3 ± 12.7 percent in the tendon transfer group and 80.7 ± 10.2 percent in the tendon grafting group. There were no significant differences between the two groups in the final follow-up total active motion percentage and quick Disabilities of the Arm, Shoulder and Hand scores. The functional outcomes of both tendon grafting and tendon transfer were acceptable based on evaluating the active contraction distance and passive distraction distance of the ruptured musculotendinous unit during wide-awake surgery. Evaluating these distances may be a useful index to assess the ruptured musculotendinous unit. The greatest advantage of the wide-awake tendon reconstruction is that surgeons can evaluate the ruptured musculotendinous unit and measure total active motion during surgery while adjusting suture tension. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

“…33 When comparing tendon transfers to autograft reconstruction, DASH scores are similar, although only 13 patients were assessed. 24 It is important to recognize that the results of FPL reconstruction are not predictable. We observed a large variation in outcomes, with QuickDASH scores ranging from 4.5 to 75.…”

“…6,23 Due to the low incidence of this complication, most of our knowledge comes from small case series consisting of five patients or fewer. 6,23,24 Therefore, the primary aim of this study is to analyze the radiographic features of patients who underwent volar plating and had an FPL rupture, and the secondary aim is to report the patient-reported outcomes following FPL reconstruction for tendon ruptures related to volar plating.…”

“…6 23 Due to the low incidence of this complication, most of our knowledge comes from small case series consisting of five patients or fewer. 6 23 24…”

Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon Rupture

“…This study was approved by the ethics committee at the University of Toyama (Toyama, Japan) (clinical research number [21][22]. Informed consent was obtained from each patient.…”

“…Furthermore, we have previously reported how to evaluate ruptured musculotendinous units during WALANT surgery. 20 , 21 This new technique is useful for evaluating the musculotendinous unit for tendon reconstruction and allows the selection of adequate muscle, potentially contributing to better clinical outcomes. Thus, it may serve as an index for choosing between tendon grafting and tendon transfer.…”