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A Reconstructive Extensor Tendon Centralization Technique for Sagittal Band Disruption.

Oleksandra Vyrva1, Julie Kvann1, Michael Karpinsky2

  • 1Christine M Kleinert Institute for Hand and Microsurgery, Louisville, KY.

Techniques in Hand & Upper Extremity Surgery
|September 10, 2019
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Summary

Sagittal band injuries causing extensor digitorum communis (EDC) tendon instability can be treated with a novel flap technique. This method reduces repair tension during metacarpophalangeal joint (MCPJ) flexion, improving outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Musculoskeletal Research

Background:

  • Sagittal band injuries can lead to extensor digitorum communis (EDC) tendon instability.
  • This instability may cause loss of finger extension, pain, and metacarpophalangeal joint (MCPJ) snapping, often requiring surgical intervention.
  • Current operative methods for EDC tendon stabilization vary in donor tissue and anchor point selection.

Purpose of the Study:

  • To present a novel surgical technique for EDC tendon stabilization.
  • To evaluate a method that reduces repair tension during MCPJ flexion.
  • To compare the biomechanical effects of different anchor points for tendon reconstruction.

Main Methods:

  • A retrospective case series of 22 patients undergoing EDC tendon stabilization between 2006 and 2017.
  • Surgical technique involved a distally based EDC tendon flap sutured to the adjacent finger volar plate for tendon centralization.
  • A mathematical model analyzed repair tension at varying MCPJ flexion angles (30, 60, 90 degrees) for two anchor points: deep transverse metacarpal ligament and adjacent volar plate.

Main Results:

  • All 22 digits achieved successful tendon centralization without subluxation postoperatively.
  • All patients experienced resolution of clinical symptoms, including pain and weakness.
  • Mathematical modeling demonstrated significantly lower tensile forces with volar plate attachment compared to intermetacarpal ligament attachment during MCPJ flexion.

Conclusions:

  • A distally based EDC tendon flap sutured to the adjacent volar plate is an effective technique for stabilizing unstable extensor tendons.
  • This surgical approach effectively reduces tensile forces on the reconstructed tendon during MCPJ flexion.
  • The technique provides successful clinical outcomes, resolving pain and improving finger extension in patients with sagittal band injuries.