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

Johnny Abboud; Ziad Sader; Charles Henry Flouzat-Lachaniette; Arnaud Dubory; Mohamad K Moussa; Sybille Facca; Nancy Zeaiter; Bassem Souleiman; Mohamad Houssein Jaber; Anthony Tannous; Tanios Dagher; Maher Ghandour

doi:10.1016/j.jor.2023.11.026

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

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

Authors

Affiliations

¹ CHU Henri Mondor, Université Paris Est, 1 rue Gustave Eiffel, 94000, Créteil, France.
² Service d'Orthopédie et Traumatologie, Hôpitaux Civils de Colmar, France.
³ Clinique du sport, Paris V, France.
⁴ Orthopedic and Hand Surgery Dept, SOS Hand Group Practice, Strasbourg University Hospitals, 10, avenue Achille-Baumann, 67403, Illkirch cedex, France.
⁵ Plastic Surgery Department, Lebanese University, Beirut, Lebanon.
⁶ Orthopedic Department, Lebanese University, Beirut, Lebanon.
⁷ Orthopedic Department, Heidelberg University Hospital, Germany.
⁸ Department of Orthopedics Surgery, CHU Grenoble Alpes, 38000, Grenoble, France.

PMID: 38059217
PMCID: PMC10696201 (available on 2025-02-01)
DOI: 10.1016/j.jor.2023.11.026

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.

Publication types

Review