Interposition grafting material is used frequently to treat osteoarthritis of the base of the thumb or tendinous and ligamentous injuries of the hand. The observation of duplicated tendons in the first dorsal compartment of the hand prompted us to explore the possibility of using the accessory abductor pollicis longus (AAPL) tendon as grafting material. Based on dissections of 78 cadaveric upper limbs, we describe the number of tendons in the first dorsal compartment of the hand, the number of muscle bellies, their innervation, their insertion site, and the tendon dimensions to determine whether the AAPL can be considered a true tendon. The AAPL was present in 85% of the hands. Average length, width, and thickness (in millimeters) of the APL were of 69.3, 5.2, and 2.1, respectively. Average length, width, and thickness (in millimeters) of the AAPL were of 69.2, 3.3, and 1.6, respectively. No differences in dimension of the tendons were found between the APL and the AAPL. The dimensions of the tendinous portion of the AAPL are similar to those of the APL and can be considered a true tendon. When present, the AAPL is a suitable source of local grafting material.

Different types of secondary reconstruction of extensor pollicis longus tendon injuries have been reported, with repair using the extensor indicis proprius being the gold standard. This technique, however, may decrease extension strength and independent extension of the index finger. We presumed repair with the accessory abductor pollicis longus would achieve functional motion of the thumb and avoid donor site morbidity. We retrospectively report the results for 11 consecutive patients who had repair with the accessory abductor pollicis longus and were followed prospectively for a minimum of 2 years. Study-specific outcome measures were used to assess function in activities of daily living, pain, and patient satisfaction. According to the score described by Geld-macher et al, good or excellent results were achieved in all cases. Mean abduction deficit of the thumb was 10 degrees compared with the uninjured side. Using a 0- to 10-point visual analog scale self-reporting questionnaire, patients obtained mean results of 7.9 points for pain, 7.5 points for activities of daily living, and 7.6 points for patient satisfaction. We recommend the accessory abductor pollicis longus as an alternative for extensor pollicis longus tendon repair.

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