||Tendon transfer or tendon graft for ruptured extensor tendons in rheumatoid hands
Chung U.S., Lee K.H., Park H.S., Kim J.H. (Gunpo, Seoul, Koyang)
Introduction: Tendon rupture occurs often in rheumatoid hands and extensor tendon ruptures more common than flexor tendon. Tendon transfer or tendon graft are treatment modalities for reconstruction, but the result of these procedures are variable. The purpose of study is to evaluate the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and to investigate parameters related with the clinical outcome.
Materials & Method: From 1995 to 2006, ruptured extensor tendons in rheumatoid hands were treated in 51 wrists of 46 patients. These tendon ruptures were managed with reconstructive procedures(mostly tendon transfer or tendon graft) combined with synovectomy, posterior interosseous neurectomy and hemiresectional arthroplasty. The clinical outcome was assessed with Geldmacher`s criteria and the patient satisfaction was measured with a visual analog scale.
Results: The mean follow up period was 5.6 years. At final follow-up, the Mean MP joint extension lag was 7.73 degree, the mean visual analog satisfaction scale was 74. Reoperation was in 1 case and 5 cases had a failure of extension. No difference of clinical outcome between tendon grafting and tendon transfer was found. The MP joint extension lag, Geldmacher score and patient satisfaction scale was related to the number of affected finger(p<0.05). The MP joint extension lag correlated with patient satisfaction scale. The duration of untreated rupture was longer, the MP joint extension lag was larger.
Conclusion: For satisfactory result, the restoration of extension should be done. Both tendon graft and tendon transfer are reliable reconstruction methods for ruptured extensor tendons in rheumatoid hands. The longer duration of untreated rupture, three or more affected fingers have relation with poor clinical outcome.