To the Editor:
We read with great interest the article by Oda et al1 entitled “Dynamic tenodesis technique for ulnar drift with extensor tendon subluxation due to rheumatoid arthritis,” which presents excellent midterm outcomes using an innovative anchor-based dynamic tenodesis for ulnar drift correction. The technique’s focus on joint preservation in controlled rheumatoid arthritis, with favorable Disabilities of the Arm, Shoulder and Hand (DASH) and Michigan Hand Questionnaire (MHQ) scores and no recurrence, is noteworthy. This approach provides a promising alternative to traditional soft tissue procedures, which often show high relapse rates because of degenerated rheumatoid tissue.2
However, some key clinical and biomechanical considerations merit discussion. The study lacks a direct comparison with established techniques such as the crossed intrinsic transfer or pant-over-vest repair.3 As intrinsic release or lengthening was performed in several cases, the distinct contribution of the dynamic tenodesis (half-slip tendon anchored to the metacarpal head) remains uncertain. Comparative or paired-finger studies could better define the incremental benefit of the bone-anchored element.
Additionally, although a mild reduction in metacarpophalangeal flexion was noted, four fingers demonstrated decreased flexion after surgery. Although attributed to the “cam-shaped” metacarpal head, extensor over-tensioning following step-cut lengthening may also contribute. Achieving precise isometric fixation intraoperatively remains challenging and may risk flexion limitation, as seen in other tendon reconstructions.4 Biomechanical studies assessing tenodesis tensioning relative to flexion excursion would strengthen the claim of isometric restoration.5
Finally, long-term radiographic follow-up correlating correction maintenance (Fearnley stage) with articular preservation (Larsen grade) would clarify whether soft tissue-only reconstruction prevents late-stage degeneration.
The described dynamic tenodesis is an elegant solution to rheumatoid arthritis-related ulnar drift. Further comparative and biomechanical validation will help define its long-term role in rheumatoid hand surgery.
Declaration of Generative AI and AI-Assisted Technologies in the Writing Process
During the preparation of this work, the authors used Gemini pro for grammar refinement. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Conflicts of Interest
No benefits in any form have been received or will be received related directly to this article.
References
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