Autogenous palmaris longus tendon grafting is effective for repairing ruptured extensor tendons in the wrist in patients with rheumatoid arthritis (RA), according to a report in the April 24th Journal of Orthopaedic Surgery and Research.
"Primary end-to-end suture is not a feasible method in RA patients," Dr. Jui-Tien Shih from the Taoyuan Armed Forces General Hospital, Taiwan told Reuters Health. "Free tendon grafting can provide sufficient length, and strong suture technique can provide sufficient strength."
Dr. Shih and associates reviewed the clinical outcome of 14 middle-aged RA patients who had had 36 extensor-tendon ruptures and had undergone tendon reconstruction incorporating autogenous palmaris tendon grafting of the multiple extensor tendons at wrist level.
Mean flexion of the metacarpophalangeal (MCP) joint an average of 54.1 months after surgery was 66 degrees, the authors report, and the extension lag at these joints had significantly improved from a mean of 38 degrees preoperatively to 16 degrees postoperatively.
All patients reported satisfaction with the clinical results of their reconstruction, the researchers note, and all had returned to their previous occupations.
There were no serious postoperative complications, and no patient lost MCP flexion due to graft overtension or MCP extension contracture, the investigators say.
"Autogenous palmaris tendon grafting is able to be used as a surgical repair technique for ruptured tendons," Dr. Shih concluded. "The free tendon graft can also be used as an interposition tissue graft in surgical treatment of thumb basal joint arthritis."
"Strong suture technique may encourage early rehabilitation (and prevent adhesion)," Dr. Shih added, "and dynamic splinting associated with an early rehabilitation program may achieve satisfactory results."
J Orthopaedic Surg Res 2008;3.
Reviewed by Ramaz Mitaishvili, MD
