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Review
. 2023 Nov 16:48:25-31.
doi: 10.1016/j.jor.2023.11.026. eCollection 2024 Feb.

The comparative efficacy of nerve transfer versus tendon transfer in the management of radial palsy: A systematic review and meta-analysis

Johnny Abboud  1 , Ziad Sader  2 , Charles Henry Flouzat-Lachaniette  1 , Arnaud Dubory  1 , Mohamad K Moussa  3 , Sybille Facca  4 , Nancy Zeaiter  5 , Bassem Souleiman  6 , Mohamad Houssein Jaber  6 , Anthony Tannous  6 , Tanios Dagher  6 , Maher Ghandour  6   7   8
Affiliations
Review

The comparative efficacy of nerve transfer versus tendon transfer in the management of radial palsy: A systematic review and meta-analysis

Johnny Abboud et al. J Orthop. .

Abstract

Background: There is no clear census as to which operative technique provides better recovery for radial nerve injuries. Therefore, in this systematic review, we examined the functional recovery, patient-reported outcomes, and complications of tendon transfer (TT) and nerve transfer (NT).

Methods: Five electronic databases were searched for studies (>10 cases per study) comparing NT and TT regardless of the study design (observational or experimental). Manual search was also conducted. The quality was assessed by the NIH tool. Outcomes included functional recovery, patient-reported outcomes (DASH score, satisfaction, and inability to return to work), and complications. The prevalence was pooled across studies using STATA software, and then, a subgroup analysis based on the intervention type.

Results: Twenty-one studies (542 patients) were analyzed. Excellent recovery, assessed by the Bincaz scale, was higher in the TT group (29 % vs. 11 %) as well as failure to extend the fingers (49 % vs. 9 %). No significant difference was noted between both groups regarding DASH score (mean difference = -2.76; 95 % CI: -12.66: 6.93). Satisfaction was great in the TT group (89 %) with a limited proportion of patients unable to return to work (7 %). Complications were slightly higher in the TT group (8 % vs. 7 %) while 18 % of patients undergoing TT requiring revision surgery. Radial deviation was encountered in 18 % of patients in the TT group and 0 % in the NT group. The quality was good, fair, and poor in 2, 13, and 6, respectively.

Conclusions: In radial nerve injuries, although tendon transfer may seem to provide better functional motor recovery than nerve transfer, it is associated with a higher rate of failure to extend the finger. Given the large confidence interval, the accuracy of this finding is questioned. However, a great proportion of those patients require revision surgery afterward. Additionally, tendon transfer is associated with a greater complication rate than nerve transfer, particularly radial deviation.

Keywords: Functional recovery; Motor recovery; Nerve transfer; Radial palsy; Tendon transfer.

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Conflict of interest statement

All of the study authors declare no competing interested associated with the conduct of this research.

Figures

Fig. 1
Fig. 1
PRISMA diagram showing the results of the database and screening phases.
Fig. 2
Fig. 2
Forest plot showing the prevalence rate of motor recovery (MRC ≥4) for wrist extension stratified by the type of surgery.
Fig. 3
Fig. 3
Forest plot showing the prevalence rate of motor recovery (MRC ≥4) for finger/thumb extension stratified by the type of surgery.
Fig. 4
Fig. 4
Forest plot showing the prevalence rate of excellent motor recovery (according to Bincaz scale) stratified by the type of surgery.
Fig. 5
Fig. 5
Forest plot showing the difference in DASH score between nerve transfer and tendon transfer.
Fig. 6
Fig. 6
Forest plot showing the prevalence rate of satisfaction stratified by the type of surgery.
Supplementary Fig. 1
Supplementary Fig. 1
Forest plot showing the prevalence rate of fair motor recovery (according to Bincaz scale) stratified by the type of surgery.
Supplementary Fig. 2
Supplementary Fig. 2
Forest plot showing the prevalence rate of good motor recovery (according to Bincaz scale) stratified by the type of surgery.
Supplementary Fig. 3
Supplementary Fig. 3
Forest plot showing the prevalence rate of poor motor recovery (according to Bincaz scale) stratified by the type of surgery.
Supplementary Fig. 4
Supplementary Fig. 4
Forest plot showing the prevalence rate of failure in finger extension stratified by the type of surgery.
Supplementary Fig. 5
Supplementary Fig. 5
Forest plot showing the prevalence rate of wrist flexion limitation stratified by the type of surgery.
Supplementary Fig. 6
Supplementary Fig. 6
Forest plot showing the prevalence rate of the inability to return to work or maintain activities of daily living stratified by the type of surgery.
Supplementary Fig. 7
Supplementary Fig. 7
Forest plot showing the prevalence rate of complications stratified by the type of surgery.
Supplementary Fig. 8
Supplementary Fig. 8
Forest plot showing the prevalence rate of revision surgery stratified by the type of surgery.
Supplementary Fig. 9
Supplementary Fig. 9
Forest plot showing the prevalence rate of radial deviation stratified by the type of surgery.
See this image and copyright information in PMC

References

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