Background/Purpose: Extensor tendon rupture seen in patients with rheumatoid arthritis (RA) is usually surgically treated in combination with extensor tendon reconstruction and wrist arthroplasty. However, limited data exist in literature concerning factors significantly correlating with poor prognosis of the extensor tendon reconstruction.  The purpose of this study is to investigate factors significantly correlating with poor prognosis of the extensor tendon reconstruction.

Methods: Total of 68 RA patients (mean age of 52 years old ; 57 females) who underwent combined surgical procedures of tendon reconstruction and wrist arthroplasty because of spontaneous extensor tendon ruptures were investigated.  The result of extensor tendon reconstruction was evaluated as “good”, “fair” and “poor” . This evaluation was defined based on active flexion and extension lag of metacarophalangeal (MP) joint of the affected fingers at 3 months after the surgery. The cases in which active flexion arc was greater than 45 degrees and extension lag was less than 15 degrees were defined as “good”. The cases, in which active flexion arc was greater than 45 degrees and extension lag ranged from 15 to 45 degrees , or active flexion arc was less than 45 degrees and extension lag was less than 15 degrees , were defined as “fair”. All other cases were defined as “poor”. We investigated the relation among clinical factors such as age at surgery, the number of ruptured extensor tendons, duration between onset of rupture and surgery, methods for reconstructing ruptured tendons, surgical procedures for wrist arthroplasty, the time interval between surgery and beginning of postoperative rehabilitation, and the frequency of ambulatory visit for rehabilitation, and the postoperative results by using multiple regression analysis. The correlation between factors relating to the postoperative result and duration between onset of rupture and surgery were additionally analyzed using single regression analysis.

Results: Forty-two (61.8%) patients were evaluated as “good”, while 19(28.0%) and 7(10.3%) patients were evaluated as “fair” and “poor”, respectively.  Number of ruptured tendons was the only independent variable which significantly related to poor postoperative results (p=0.0002).   The longer duration between onset of rupture and surgery had significant correlation between increased number of ruptured tendons (p=0.03).

Conclusion: Increased number of ruptured extensor tendons significantly correlated with poor postoperative result of extensor tendon reconstruction in patients with RA. The number of increased ruptured extensor tendons also significantly correlated with duration between onset of rupture and surgery.  We therefore recommend surgical intervention at early stage of extensor tendon rupture, in which only few tendons are suspected to be involved, to result in better prognosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-number-of-ruptured-tendons-as-a-prognostic-factor-for-reconstructing-extensor-tendon-rupture-in-patients-with-rheumatoid-arthritis/