gms | German Medical Science

Objectives/Interrogation: In extensor pollicis longus (EPL) tendon reconstruction, 3 factors are important to obtain optimum post-operative thumb motion: the reconstruction method of either extensor indicis proprius tendon transfer (EIP TT) or free tendon graft (FTG), the tension applied to the EPL tendon and the muscle selection for the power source. Based on these, we have hypothesized that: 1) results are similar between EIP TT and FTG, and 2) our novel 2 cm retropulsion tension method is reliable for consistently deciding optimal tension.

Methods: Twenty-five consecutive patients with chronic rupture of the EPL tendon were treated by EIP TT or FTG between 2006 and 2014 by 3 different surgeons. EPL tendon rupture occurred after distal radius fracture in most cases. For all patients, tendon reconstruction was performed using a novel retropulsion tension method, in which we reconstructed the EPL tendon keeping the center of the thumb nail raised 2 cm above the operating table while the palm was pressed against the operation table with the elbow in extension, forearm in pronation, and wrist in a neutral position. FTG was carried out using the palmaris longus tendon within 3 months from episode to surgery in 7 patients. EIP TT was done in 13 patients after more than 3 months from episode to surgery. We examined 20 patients directly a minimum of 12 months after tendon reconstruction to assess Total Active Motion (TAM) of the thumb, elevation deficit of the thumb compared with the opposite thumb in active retropulsion position, flexion deficit of the thumb interphalangeal and metacarpophalangeal joints, and disabilities of the arm, shoulder and hand (DASH) scores.

Results and Conclusions: Mean TAM improved from preoperative 50% (range: 18-78%) to postoperative 90% (range: 60-100%). Mean elevation deficit was 1.2 cm (range: 0-2.5 cm) and mean flexion deficit was 10 degrees (range: -12-45 degrees) at follow-up. Mean DASH score improved from 28.6 to 7.7. There were no significant differences in clinical outcome between EIP TT and FTG or among the results of individual surgeons.

Various tension-deciding techniques have been proposed for EPL tendon reconstruction. By raising the thumb by 2 cm, we believe our new retropulsion tension technique is easy, reliable, and applicable for both EIP TT and FTG. With results comparable to EIP TT, FTG is recommended for patients within 3 months after tendon rupture to preserve independent index finger motion.