PubMed^® Literature Review

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Extensor indicis proprius (EIP) to EPL tendon transfer is the most widely adopted and effective surgical method for reconstructing extensor pollicis longus (EPL) ruptures, demonstrating favorable functional outcomes, high patient satisfaction, and a low incidence of complications, although alternative techniques are viable when EIP transfer is contraindicated.

Evidence and Analysis:

The reconstruction of the extensor pollicis longus (EPL) tendon following its rupture is critical for restoring thumb functionality. Among the various reconstruction strategies, the transfer of the extensor indicis proprius (EIP) tendon stands out as the most prevalent method. Ganon et al. [1] conducted a systematic review analyzing 18 studies encompassing 515 patients, concluding that EIP transfer remains the preferred modality due to its reliability and minimal postoperative rehabilitation requirements. In their review, follow-up durations averaged 28 months, underscoring the sustained efficacy of EIP transfers over time.

Supporting this, Stirling et al. [6] presented a cohort study involving 12 patients, where EIP transfer significantly improved QuickDASH scores from a mean of 29.7 preoperatively to 15.2 postoperatively (p=0.05), alongside enhancements in health-related quality of life metrics. The study’s Level III evidence provides moderate support for the procedure's effectiveness, although the small sample size warrants cautious interpretation.

Retrospective case series further reinforce these findings. Cha et al. [2] reported five cases where primary EPL repair was feasible in select patients, but ultimately maintained the stance on EIP transfer as a reliable fallback. Similarly, Adams et al. [7] documented favorable long-term outcomes in seven patients following EIP to EPL transfers, with mean QuickDASH scores of 16±14, highlighting the procedure's durability.

Case reports, while inherently limited in generalizability, consistently endorse the EIP transfer approach. For instance, Patel et al. [5] detailed a successful EIP transfer in a skeletally immature patient, emphasizing the technique's adaptability across diverse patient populations. Conversely, Gelb [4] from 1995, one of the earliest comprehensive reviews, already recommended EIP transfer as the most predictable method, a stance that subsequent studies have continued to uphold.

However, alternative methods are occasionally necessitated. Fernández-Mardomingo Gutiérrez et al. [3] and Sabat et al. [9] illustrated cases where patient-specific factors precluded EIP transfer, necessitating grafting options. Additionally, the protocol by Meiwandi et al. [11] for comparing EIP and palmaris longus (PL) tendon grafting indicates ongoing research to evaluate alternative reconstruction techniques, although concrete comparative data remain forthcoming.

Complications associated with EIP transfer are infrequently reported. Adams et al. [7] and Stirling et al. [6] noted minimal adverse outcomes, aligning with Gelb’s earlier assertions regarding the procedure's safety profile [4]. However, the predominantly lower-level evidence (Levels IV and V) among case reports suggests a need for higher-level studies to robustly validate these findings and potentially uncover less common complications.

Discussion:

The extensor indicis proprius to EPL tendon transfer is consistently evidenced as an effective and reliable method for reconstructing EPL ruptures, offering significant functional restoration and patient satisfaction with minimal complications. Despite the predominance of lower-level evidence, the convergence of multiple studies and case reports supports the widespread clinical adoption of EIP transfer. Nevertheless, the limited high-level evidence underscores the necessity for more rigorous, large-scale studies to further validate these outcomes and explore alternative reconstruction techniques when EIP transfer is contraindicated.

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