Rheumatoid Arthritis Tendon Transfers - Patrick Lusty 9/1/2001

Background

Principles of Tendon Transfers according to Boyes (Boyes J H: Bunnell's Surgery of the Hand. Edition 5 Philadelphia, J B Lippincott, 1970)

  1. Correction of contracture before transfer
  2. Adequate power, not too weak or strong
  3. Sufficient Amplitude
  4. Straight line of pull
  5. Maintenance of integrity of he muscle , one muscle can not act in two different places

Pattern of tendon rupture in Rheumatoid Arthritis

  1. EPL often isolated, X rays may not show RA changes
  2. Extensor tendon rupture, EDM commonest, subsequently progressing radialward. Due to erosion of the distal ulna through the dorsal capsule (Vaughan-Jackson type)
  3. FPL most common flexor tendon to rupture

Brief MOUNTNEY, J of Hand Surgery 1998
Author Mountney J, Blundell C M, et al
Title Free tendon interposition grafting for the repair of ruptured extensor tendons in the rheumatoid hand
Reference Journal of Hand Surgery 1998; 23B: 5: 662-665
Summary Discusses the use of interposition grafting using PL for ED rupture in rheumatoid arthritis rather than traditional end to side tendon transfer. Gives a biomechanical argument to support interposition grafts as well as a review of patients who had this procedure.
Critique Good Biomechanical argument. 7 rheumatoid hands with 16 extensor tendon repairs, review average 17 months all had interposition grafting, retrospective no data on alternative methods to compare with.



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