Tendon grafting for extensor tendon ruptures in patients with rheumatoid arthritis and distal radioulnar joint osteoarthritis

Extensor tendon ruptures of the fingers are a common and disabling complication of both rheumatoid arthritis (RA) and distal radioulnar joint (DRUJ) osteoarthritis (OA). Tendon grafting may restore extensor function with favorable results. The aim of this study is to report and compare the clinical outcomes of tendon grafting for extensor tendon ruptures caused by RA and DRUJ OA.

From 2012 to 2022, we included 14 patients with extensor tendon ruptures who had a minimum of 12 months of follow-up. Overall, 7 patients with ruptures caused by DRUJ OA and 7 patients with those caused by RA were treated with tendon grafting, using interposing palmaris longus tendon grafts.

The median age of the patients was 55 years (range, 27-84). After a median follow-up period of 48 months (range, 12-178), the median visual analog scale (VAS) pain, Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score (MMWS), and grip strength of contralateral side showed significant improvements (VAS: 4 vs 0, DASH: 31.8 vs 4.5, MMWS: 50 vs 75, and grip strength: 77% vs 101%). In subgroup analysis, the DASH score improved significantly in both groups, while VAS pain, MMWS, grip strength, and supination showed significant improvement in the DRUJ OA group, but no significant difference was observed in the RA group. One patient in the DRUJ OA group experienced an extension lag, while three patients did in the RA group. No re-rupture was reported.

Tendon grafting can achieve satisfactory functional outcomes in extensor tendon ruptures caused by RA and DRUJ OA. However, outcomes for VAS pain, MMWS, grip strength, and supination are less promising in patients with RA.

Keywords: Extensor tendon ruptures, rheumatoid arthritis, distal radioulnar joint osteoarthritis