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Background: Tendon gliding is key to functional recovery following tendon injury. Gliding is facilitated by both the integrity of the repair and a low-friction gliding surface. Generally, this gliding surface is provided by the periosteum of the underlying bone. However, significant injuries may damage the periosteum, which must be reconstructed to allow for adequate and uninterrupted tendon excursion. Without repair, these complicated injuries may compromise the ability of a repaired tendon to glide freely.

Methods: Four patients underwent surgical repair of flexor and/or extensor tendons in the hand following either traumatic injuries or tumor excision. In all patients, tendon grafting was necessary to repair a severed tendon. Additionally, all patients had disruption of the dorsal bony cortex underlying the tendon injury including periosteal loss. In two patients, the defect was localized to the DIPJ, in one patient the defect was at the level of the PIPJ, and in one patient the defect was at the MCPJ. Because bone devoid of its periosteum does not provide a low-friction gliding surface, an ipsilateral extensor retinaculum graft was used to fill the defect. Through an incision on the dorsal ipsilateral wrist, an extensor retinaculum graft corresponding to the size of the periosteal defect was harvested. It was then sutured into place overlying the bone cortex.

Results: By 8 months post-op, all four patients had complete return to function. Additionally, all patients had near normal strength in the repaired hand along with excellent tendon excursion in both flexion and extension.

Conclusion: Extensor retinaculum grafting recreates a periosteal gliding surface that improves tendon gliding. This technique is easily employed, utilizes autogenous tissues with minimal to no donor site morbidity and the results we have seen have been excellent. The histologic similarities between extensor retinaculum and periosteum add scientific merit to this novel approach(1,2). By utilizing extensor retinaculum grafts in these patients, we were able to restore tendon integrity with excellent recovery times and return to function.

References: 1. Allen, M.R., Hock, J.M. & Burr, D.B. Periosteum: biology, regulation, and response to osteoporosis therapies. Bone 35, 1003-1012 (2004). 2. Klein, D.M., Katzman, B.M., Mesa, J.A., Lipton, J.F. & Caligiuri, D.A. Histology of the extensor retinaculum of the wrist and the ankle. J Hand Surg Am 24, 799-802 (1999).