58 - Hauptsitzung
16. Mai 2019, 13:45 - 15:15, Kursaal Arena, 5. OG
Shorter rehabilitation after extensor pollicis longus reconstruction combining side-to-side tendon attachment and new active rehabilitation protocol
T. Cordier, S. Schibli, Presenter: T. Cordier (Chur)
Rupture of the Extensor pollicis longus tendon (EPL) is frequently associated with distal radius fractures. For EPL reconstruction the Extensor indicis tendon (EI) is transferred to the distal end of the EPL. Common suture techniques combined with established rehabilitation protocols have proven to achieve good results. However, patients regularly experience restrictions of hand function for three months. In addition, current rehabilitation protocols tend to be complex and depend on substantial support from hand therapists. Compared to the Pulvertaft technique, the Side-to-Side (STS) suture technique provides improved strength and has been successfully implemented for tendon transfers. In this prospective study we analysed, wether combining a Side-to-Side suture technique with a straightforward active rehabilitation protocol based on the increased suture stability simplifies and shortens time of rehabilitation after EPL reconstruction.
Between 11/2015 and 04/2017 we treated a series of 10 patients, median age 56 (range 18-70) after closed EPL-rupture using STS suture technique for EI to EPL transfer. For postoperative rehabilitation we implemented a simplified Controlled-Active-Motion protocol. Clinical follow up was at 2, 4 and 8 weeks postoperatively and additionally one year later by phone. Primary endpoints were the unrestricted use of the operated hand or major complications, defined as tendon rupture or relevant tendon elongation. We reported on patient satisfaction and pain. As objective parameter active range of motion of the thumb and index finger as well as pinch and grip strength were measured.
All 10 patients underwent surgery and postoperative rehabilitation without complication. All 10 were satisfied with the treatment 8 weeks and one year postoperatively. All were back to work after 8 weeks or could use the operated hand without any restriction. At 8 weeks all patients achieved a powerful active extension of the IP-joint of the thumb. Pinch- and grip- strength reached on average 83% and 81% of the contralateral side.
Despite the small group and the relative short follow up the results suggest that the Side-to-side suture technique in combination with an adapted active rehabilitation protocol provides a safe and successful method for EPL reconstruction. Compared with the current literature this concept shortens time of rehabilitation by a third.