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Extensor Indicis Proprius Transfers Versus Tendon Graft in Extensor Pollicis Longus Reconstruction: A Systematic
Daniel J Keating1, Simon J Maciburko1, Pradyumna Herle1
1St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Background:
In extensor pollicis longus ruptures not amenable to primary repair, secondary reconstruction of the tendon has traditionally been performed using either extensor indicis transposition or free tendon graft techniques. This paper constitutes a systematic review and meta-analysis of the current literature with a focus on Geldmacher's scoring to identify the effectiveness of these procedures.
Methods:
We performed a literature search of medical databases to identify papers fulfilling the inclusion criteria. A meta-analysis abiding by Preferred Reporting Items of Systematic Reviews and Meta-analyses was completed with Geldmacher's score as a primary outcome and objective measurement of functional recovery following each procedure.
Results:
Nine papers were identified and included in the meta-analysis following independent review by three researchers. On analysis of the data, "very good" and "good" Geldmacher's scores were achieved in 81.8% of patients who underwent extensor indicis transfer and 87.5% of patients who underwent tendon grafting. These results suggest that both techniques represent an equivalent return to postoperative function.
Conclusions:
This systematic review and meta-analysis found that both extensor indicis transfer and tendon graft provide a practically equivalent return to function following extensor pollicis longus reconstruction. However, clinical limitations of tendon grafting, along with theoretical models of tendon repair may suggest extensor indicis as a more reliable means of reconstruction.
