Flexor Tendon Pulley Reconstruction

Clark, Tod A.; Skeete, Kshamata; Amadio, Peter C.

doi:10.1016/j.jhsa.2010.07.029

Cited by 36 publications

(28 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although our available data do not contain the level of detail needed to compare this risk between reconstruction techniques, this may be appropriate for future clinical investigation, given the relative advantages and disadvantages of each technique. 12–14 …”

Section: Discussionmentioning

confidence: 99%

“…Although the anatomy, biomechanics, and surgical technique of flexor pulley reconstruction have been extensively reviewed, 10–14 the incidence and risk profile of having surgery remain incompletely explored. We used a statewide administrative database to determine the incidence of flexor pulley reconstruction and to evaluate the influence of demographic characteristics on the frequency of secondary surgery.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Epidemiology of Reoperation After Flexor Pulley Reconstruction

Lyman

Schreiber

et al. 2013

The Journal of Hand Surgery

View full text Add to dashboard Cite

Purpose We used a statewide database to determine the incidence of pulley reconstruction and to evaluate the influence of demographics on reoperation. We hypothesized that age, insurance status, and concomitant nerve or tendon procedure would influence the likelihood of reoperation. Methods We used the Statewide Planning and Research Cooperative System ambulatory surgery database from New York, which represents all outpatient surgery in the state. Patients who had flexor pulley reconstruction from 1998 to 2009 were identified using Current Procedural Terminology 4 codes. Subsequent surgery records for these patients were identified through 2010, allowing at least 1 year follow-up. Concomitant nerve procedure and flexor tendon repair/reconstruction were identified. The type and timing of subsequent procedures, including tenolysis and repeat pulley reconstruction, were recorded. Univariate statistics were calculated to compare age, sex, and payer type between patients with and without reoperation. A multivariable, logistic regression model was used to evaluate the association of the demographics with the chances of having reoperation. Results There were 623 patients who had flexor pulley reconstruction from 1998 to 2009. The incidence of pulley reconstruction was 0.27 per 100,000 persons, with an annual frequency of 52 procedures. There were 39 (6%) reoperations. There was no difference in age, concomitant nerve or tendon repair, or workers’ compensation between patients with and without reoperation. Regression modeling showed a higher likelihood among men of having reoperation. Conclusions Flexor pulley reconstructions are rare. One-quarter of surgeons performed only one flexor pulley reconstruction over a 12-year period. The 6% reoperation rate is similar to our previous findings for flexor tendon repair using similar methodology. Our report provides information that may be useful in counseling patients. Type of study/level of evidence Prognostic II.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Epidemiology of Reoperation After Flexor Pulley Reconstruction

Lyman

Schreiber

et al. 2013

The Journal of Hand Surgery

View full text Add to dashboard Cite

show abstract

“…Currently the most common graft choices are palmaris longus or flexor carpi radialis and are used for procedures such as interposition arthroplasty (15), tendon grafts, or pulley reconstruction (16,17). However, the small size (3.1mm 2 (18)) and inconsistent presence (19) of the palmaris longus tendon diminishes its utility (20), and flexor carpi radialis harvest may result in uneven and altered wrist function (21).…”

Section: Discussionmentioning

confidence: 99%

Functional Consequence of Distal Brachioradialis Tendon Release: A Biomechanical Study

Tirrell

Franko

Bhola

et al. 2013

The Journal of Hand Surgery

View full text Add to dashboard Cite

Purpose Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, this common procedure has the potential to decrease elbow flexion strength. To determine the potential morbidity associated with brachioradialis release, we measured the change in elbow torque as a function of incremental release of the brachioradialis insertion footprint. Methods In 5 upper extremity cadaveric specimens, the brachioradialis tendon was systematically released from the radius, and the resultant effect on brachioradialis elbow flexion torque was measured. Release distance was defined as the distance between the release point and the tip of the radial styloid. Results Brachioradialis elbow flexion torque dropped to 95%, 90% and 86% of its original value at release distances of 27mm, 46mm, and 52mm, respectively. Importantly, brachioradialis torque remained above 80% of its original value at release distances up to 7 centimeters. Conclusions Our data demonstrate that release of the brachioradialis tendon from its insertion has minor effects on its ability to transmit force to the distal radius. Clinical Relevance These data may imply that release of the distal brachioradialis tendon during distal radius open reduction internal fixation can be performed without meaningful functional consequences to elbow flexion torque. Even at large release distances, overall elbow flexion torque loss after brachioradialis release would be expected to be less than 5% due to the much larger contributions of the biceps and brachialis. Use of the brachioradialis as a tendon transfer donor should not be limited by concerns of elbow flexion loss, and the tendon could be considered as an autograft donor.

show abstract

“…8 Grafts from the extensor retinaculum have been advocated as the more anatomical choice. 9–11 Nevertheless, Bouyer described in the largest series extensor tendon bowstringing at the donor site in more than 25%. 6 Therefore, other donor sites should be considered.…”

Section: Methodsmentioning

confidence: 99%

Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft

Jakubietz

Meffert

Schmidt

et al. 2017

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background:The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present.Methods:A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley.Results:Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness.Conclusions:The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley.

show abstract

Flexor Tendon Pulley Reconstruction

Cited by 36 publications

References 12 publications

The Epidemiology of Reoperation After Flexor Pulley Reconstruction

The Epidemiology of Reoperation After Flexor Pulley Reconstruction

Functional Consequence of Distal Brachioradialis Tendon Release: A Biomechanical Study

Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft

Contact Info

Product

Resources

About