Dynamic Tenodesis Technique for Ulnar Drift With Extensor Tendon Subluxation due to Rheumatoid Arthritis

Ryo Oda; Naoki Okubo; Shogo Toyama; Shinji Tsuchida; Kenji Takahashi

doi:10.1016/j.jhsg.2025.100808

Dynamic Tenodesis Technique for Ulnar Drift With Extensor Tendon Subluxation due to Rheumatoid Arthritis

J Hand Surg Glob Online. 2025 Aug 14;7(6):100808. doi: 10.1016/j.jhsg.2025.100808. eCollection 2025 Nov.

Authors

Ryo Oda¹, Naoki Okubo¹, Shogo Toyama¹, Shinji Tsuchida¹, Kenji Takahashi¹

Affiliation

¹ Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Abstract

Purpose: We investigated the outcomes of an original functional reconstruction procedure for ulnar drift (UD) with extensor tendon subluxation due to rheumatoid arthritis.

Methods: From 2018 to 2022, reconstruction was performed in 10 patients (31 fingers), with UD due to rheumatoid arthritis and a minimum of 2-year follow-up. The mean age was 57 years, and the mean follow-up period was 4.5 years. Ulnar drift was assessed using the Fearnley classification and included 17 stage 1 cases and 14 stage 2 fingers. A half-slip tendon was created just above the metacarpal head. An anchor was driven into the center of rotation of the metacarpophalangeal (MCP) joint on the radial side of the metacarpal bone, and the half-slip tendon was sutured and fixed. If limitations were observed in the flexion of the MCP joint, the extensor tendon was step-cut, and the half-slip tendon was fixed via an interlacing suture to the step-cut distal extensor tendon. We investigated the patient's background and range of motion. The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire of patient-reported outcome measures were scored as functional outcomes.

Results: At a mean of 54 months after the operation, the average extension in the MCP joint improved from -12° (range: -80° to 28°) before surgery to 1.5° (range: -40° to 20°) at the final follow-up (P < .05), whereas the average flexion had no remarkable change. The average active arc of motion of the operated MCP joint was significantly increased to 95° (range: 60°-120°) compared with 82° (range: 34°-118°) before surgery (P < .05). The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire scores improved significantly. No recurrence of UD, such as a decreased Fearnley stage, was documented.

Conclusions: We present good results with no recurrence using a dynamic tenodesis technique as a functional reconstruction for UD with finger extensor tendon subluxation caused by rheumatoid arthritis, with a particular focus on joint preservation via soft tissue reconstruction.

Type of study/level of evidence: Therapeutic IV.

Keywords: Centralization; Extensor tendon subluxation; Rheumatoid arthritis; Ulnar drift.