New Surgery for Extensor Pollicis Longus Tendon Rupture
This study presents the results of 11 patients treated with a tendon transfer for rupture of the extensor pollicis longus (EPL). The EPL is a tendon that extends (straightens) the thumb. The rupture was caused by a wrist fracture.

The standard operation for this injury is to use the extensor indicis proprius (EIP) tendon. The tendon is transferred from its normal location to replace the function of the EPL.

There are some disadvantages of using the EIP. So the surgeon tried using the accessory abductor pollicis longus (AAPL) instead. Accessory means extra. The abductor pollicis longus has an extra slip of tendon. It can be used (transferred) without affecting the function of the APL.

Not all people have this tendon. It is present in about 85 to 95 per cent of the general public. Results of this new method to repair the torn tendon were measured based on pain and function. Patient satisfaction was also measured.

A testing tool called the Geldmacher score was used to assess overall thumb motion. Any difficulty lifting the thumb off the table with the palm flat is a sign of donor site morbidity. This means the donor tendon lost some strength after the accessory slip was used.

This group of patients had a good outcome. Thumb motion compared favorably with results from other studies using different tendons for this repair. Thumb abduction (moving the thumb away from the palm) was better using the AAPL compared with other tendon transfers.

The authors conclude the AAPL can be used successfully to restore function of the ruptured EPL. This new surgical technique has many advantages over other tendon transfers for this injury.
Adrián Bullón, MD, et al. Reconstruction After Chronic Extensor Pollicis Longus Ruptures. In Clinical Orthopaedics and Related Research. September 2007. Vol. 462. Pp. 93-98.