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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.

ANZ Journal of Surgery

|March 9, 2026

Summary

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Extensor pollicis longus reconstruction using extensor indicis transfer or tendon grafting offers similar functional recovery. Extensor indicis transfer may be more reliable due to tendon grafting

Area of Science:

Orthopedic Surgery
Hand Surgery
Reconstructive Surgery

Background:

Extensor pollicis longus (EPL) ruptures often require secondary reconstruction when primary repair is not feasible.
Traditional secondary reconstruction methods include extensor indicis (EI) transfer and free tendon grafting.
This study systematically reviews and meta-analyzes these procedures using Geldmacher's scoring.

Purpose of the Study:

To compare the effectiveness of extensor indicis transfer versus free tendon grafting for secondary EPL reconstruction.
To evaluate functional recovery outcomes using Geldmacher's score.

Main Methods:

A systematic literature search was conducted across medical databases.
Included studies were analyzed using a meta-analysis adhering to PRISMA guidelines.

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Geldmacher's score was the primary outcome measure for functional recovery.

Main Results:

Nine studies were included in the meta-analysis.
Excellent functional outcomes (Geldmacher's scores) were reported in 81.8% of EI transfer cases and 87.5% of tendon graft cases.
Both techniques demonstrated comparable postoperative functional recovery.

Conclusions:

Extensor indicis transfer and tendon grafting provide nearly equivalent functional returns for EPL reconstruction.
Potential clinical limitations of tendon grafting suggest EI transfer may offer a more dependable reconstructive option.
Further consideration of tendon repair models supports EI transfer's reliability.