Reconstruction after Chronic Extensor Pollicis Longus Ruptures

Abstract

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.

Variations of the abductor pollicis longus tendon: an anatomic study

“…(1) is inserted into the anterolateral surface of base of 1 st metacarpal bone (*). The medial tendons (2-5); the second tendon (2) is inserted into the anterolateral surface of base of 1 st metacarpal bone (*), while the third and fourth ones (3,4) are inserted into trapezium (T). The most medial tendon (5) gives 2 slips which are inserted into trapezium (T) and abductor pollicis brevis muscle (APB).…”

“…Duplicated tendons found in the first dorsal compartment of the hand encouraged multiple studies to analyse the anatomy of this area [2]. Recent studies used the accessory tendons of the APL as grafting material for the reconstruction of ruptured extensor pollicis longus tendon [3]. However, to our knowledge, the appropriateness of these tendons for grafting purposes and their dimensions was deficient.…”

Anatomic Study of the Abductor Pollicis Longus: A Source for Grafting Material of the Hand

“…The terminology of tendon slip and accessory tendon remains equivocal. A recent study using the AAPL as grafting material for reconstruction after chronic extensor pollicis longus ruptures showed a functional ROM in all cases and a mean loss of 108 radial abduction [6]. Available studies, however, do not document tendon dimensions or the appropriateness for various grafting purposes.…”

“…The need for interposition grafting material is frequent in the treatment of osteoarthritis of the base of the thumb [13,17] or tendinous [6,15,22] and ligamentous injuries of the hand [10,14]. The use of different tendons as grafting material is extensive in hand surgery.…”

Bilateral Morphological Variation of Abductor Pollicis Longus and Extensor Pollicis Brevis Tendons: A Cadaveric Case Report with Clinical Perspective

“…These additional slips are frequently associated with clinical manifestations of first carpo-metacarpal arthritis or subluxation (11). Use of additional slips of APL as a grafting material for ruptured extensor pollicis longus reconstruction with successful functional restoration has been described (12). Further, knowledge of anatomic variants of APL is crucial during decompression of de Quervain's syndrome (13).…”