A Retrospective Cohort Study of Extensor Pollicis Longus Reconstruction Using Palmaris Longus Tendon Graft or Extensor Indicis Proprius Transfer

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Abstract
Background: Extensor pollicis longus (EPL) rupture can be managed using several surgical techniques, with palmaris longus (PL) tendon graft reconstruction and extensor indicis proprius (EIP) transfer among the most commonly used options. Comparative clinical data between these techniques remain limited, particularly regarding functional outcomes and delayed reconstruction. This retrospective cohort study evaluated functional outcomes and complications following EPL reconstruction using a PL graft or EIP transfer in a single-institution cohort. Methods: This retrospective cohort study included demographic, surgical, and outcome data of all patients who presented to our institution with an EPL rupture between 2004 and 2020. Patients were identified using Current Procedural Terminology codes, International Classification of Diseases, Ninth/Tenth Revision codes, and operating room schedules. Group comparisons were performed using Fisher exact test, χ 2 test, and t test, as appropriate; P < .05 was considered statistically significant. Results: A total of 38 patients with EPL rupture were identified, including 8 treated with PL grafts and 30 with EIP transfer. Both groups demonstrated improvement in Disabilities of the Arm, Shoulder, and Hand (DASH) scores. The PL graft group showed a larger mean reduction in DASH scores. Three patients in the EIP transfer group (11%) experienced index finger extensor lag or limited EPL function, whereas no such cases occurred in the PL graft group. Conclusion: Both PL graft reconstruction and EIP transfer were associated with postoperative functional improvement in this cohort. Although the PL graft group demonstrated a larger mean reduction in DASH scores, the marked differences in baseline characteristics and surgeon-directed treatment selection preclude firm comparative conclusions. Delayed PL graft reconstruction was nevertheless associated with acceptable postoperative outcomes in this series.

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