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Surgical and Radiologic Anatomy

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01-03-2020 | Review

Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies

Authors: Kaissar Yammine, Mirela Erić

Published in: Surgical and Radiologic Anatomy | Issue 3/2020

Abstract

Introduction

The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Easy to access and at proximity to the hand, the palmaris longus tendon is considered as the optimal tendon source for hand reconstructive surgery. However, and besides its inconsistency, the size of the palmaris longus tendon is reported to show variability. The aim of this study is to look for the surgical adequacy of the palmaris longus tendon by conducting a quantitative synthesis on its length and width in human populations and its correlation with the forearm length.

Methods

Twenty-four studies met the inclusion criteria including 1761 cadaveric limbs.

Results

The results were as following: (a) the mean palmaris longus tendon length was of 13.9 ± 2.6 cm, (b) the mean ratio palmaris longus tendon length/forearm length was of 0.545 ± 0.06, (c) the weighted correlation value was of 0.686, and (d) the mean palmaris longus tendon width was of 4.0 ± 1.7 mm. Only five studies reported a palmaris longus tendon length of more than 15 cm. The palmaris longus tendon length was shown to vary between ancestries; the Japanese had the shortest while Malaysian the longest palmaris longus tendons. All studies but one reported a palmaris longus tendon mean width of more than 3 mm where the minimal mean palmaris longus tendon width was of 2.5 mm.

Conclusion

While the requested length depends on the recipient site and/or type of reconstructive surgery, the palmaris longus tendon often met the required diameter for grafting. Our review demonstrated that while palmaris longus length varies between ancestries, its width is often adequate for grafting. In addition, the forearm length could be a good predictor of palmaris longus tendon length; such correlation could assist surgeons when planning to use palmaris longus tendon as a graft source.

Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27(2):243–251CrossRefPubMed

Alagoz MS, Uysal AC, Tuccar E, Tekdemir I (2008) Morphologic assessment of the tendon graft donor sites: palmaris longus, plantaris, tensor fascia lata. J Craniofac Surg 19(1):246–250. https://doi.org/10.1097/scs.0b013e31815c8a0f CrossRefPubMed

Angelini Júnior LC, Angelini FB, de Oliveira BC, Soares SA, Angelini LC, Cabral RH (2012) Use of the tendon of the palmaris longus muscle in surgical procedures: study on cadavers. Acta Ortop Bras 20(4):226–229. https://doi.org/10.1590/S1413-78522012000400007 CrossRefPubMedPubMedCentral

Baimai S, Predapramote P, Sricharoenvej S, Piyasilakul S (2019) Morphologic variations of palmaris longus muscle in thais. In: Proceedings of international conference on technology and social science (ICTSS 2019), pp 1–7

Carlson GD, Botte MJ, Josephs MS, Newton PO, Davis JL, Woo SL (1993) Morphologic and biomechanical comparison of tendons used as free grafts. J Hand Surg Am 18(1):76–82CrossRefPubMed

Cerda A, Del Sol M (2016) Morphology and morphometry of the tendons of the palmaris longus and radial carpal extensor muscles in humans. Int J Morphol 34(4):1515–1521. https://doi.org/10.4067/S0717-95022016000400054 CrossRef

Cinar C, Arslan H, Ogur S (2007) Reconstruction of massive lower lip defect with the composite radial forearm-palmaris longus free flap: empowered static and partial dynamic reconstruction. J Craniofac Surg 18:237–241CrossRefPubMed

Furukawa K, Pichora J, Steinmann S, Faber KJ, Johnson JA, King GJ (2007) Efficacy of interference screw and double-docking methods using palmaris longus and GraftJacket for medial collateral ligament reconstruction of the elbow. J Shoulder Elbow Surg 16:449–453. https://doi.org/10.1016/j.jse.2006.09.020 CrossRefPubMed

Gangata H (2009) The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique. Clin Anat 22:230–235. https://doi.org/10.1002/ca.20751 CrossRefPubMed

10.

Harvey FJ, Chu G, Harvey PM (1983) Surgical availability of the plantaris tendon. J Hand Surg 8:243–247. https://doi.org/10.1016/S0363-5023(83)80151-8 CrossRef

11.

Ito MM, Aoki M, Kida MY, Ishii S, Kumaki K, Tanaka S (2001) Length and width of the tendinous portion of the palmaris longus: a cadaver study of adult Japanese. J Hand Surg Am 26(4):706–710. https://doi.org/10.1053/jhsu.2001.26026 CrossRefPubMed

12.

Jain DKA, Shah HM, Ashwini S, Palla A (2017) Prediction of palmaris longus tendon length: study in Indian fresh frozen cadavers. J Orthop Educ 3(1):55–58. https://doi.org/10.21088/joe.2454.7956.3117.10 CrossRef

13.

Jakubietz MG, Jakubietz DF, Gruenert JG, Zahn R, Meffert RH, Jakubietz RG (2011) Adequacy of palmaris longus and plantaris tendons for tendon grafting. J Hand Surg Am 36(4):695–698. https://doi.org/10.1016/j.jhsa.2011.01.007 CrossRefPubMed

14.

Jang E, Dy CJ, Wolfe SW (2014) Selection of tendon grafts for distal radioulnar ligament reconstruction and report of a modified technique. J Hand Surg Am 39(10):2027–2032. https://doi.org/10.1016/j.jhsa.2014.07.020 CrossRefPubMedPubMedCentral

15.

Jianmongkol S, Thumroj E, KosuwonW Kamanarong K (2002) Palmaris longus & plantaris tendon: anatomical variations & relationship. Srinagarind Med J 17(3):160–163

16.

Johnson CC, Vutescu ES, Miller TT, Nwawka OK, Lee SK, Wolfe SW (2018) Ultrasound determination of presence, length and diameter of the palmaris longus tendon. J Hand Surg Eur 43(9):948–953. https://doi.org/10.1177/1753193418778990 CrossRef

17.

Karahan AY, Bakdik S, Ozen KE, Arslan S, Karpuz S, Yilmaz N, Yildirim P, Oncu F, Cicekcibasi A (2017) The effect of the palmaris longus muscle on wrist flexion and extension strength. Isokinet Exerc Sci 25(4):243–247. https://doi.org/10.3233/IES-171139 CrossRef

18.

Kaufmann RA, Pacek CA (2006) Pulley reconstruction using palmaris longus autograft after repeat trigger release. J Hand Surg [Br] 31:285–287. https://doi.org/10.1016/j.jhsb.2005.12.011 CrossRef

19.

Kleinert HE, Pulvertaft RG, Smith DJ (1991) Flexor tendon grafting in the hand. In: Jupiter JB (ed) Flynn’s hand surgery. Williams & Wilkins, Baltimore, pp 283–299

20.

Lakshmi GV, Princy LA (2014) Estimation of the length of palmaris longus tendon from the length of forearm—a study on Indian population. Pushpagiri Med J 5(2):84–87

21.

Lieber RL, Jacobson MD, Fazeli BM, Abrams RA, Botte MJ (1992) Architecture of selected muscles of the arm and forearm: anatomy and implications for tendon transfer. J Hand Surg Am 17(5):787–798. https://doi.org/10.1016/0363-5023(92)90444-T CrossRefPubMed

22.

Mahoney J, Kharaillah E, Drakos D (1998) Donor site morbidity following free tissue transfer: a preliminary survey. Can J Plast Surg 6(2):85–88. https://doi.org/10.1177/229255039800600204 CrossRef

23.

Manohar A, Rampal L (2013) Novel method to estimate the length of palmaris longus tendon. MJMHS 9(2):19–24

24.

Milone MT, Starecki M, Ayalon O, Aversano MW, Sapienza A (2017) The relationships between surface measurements and underlying tendon autograft length for upper extremity reconstructive surgery. J Hand Surg Am 42(8):664.e1–664.e5. https://doi.org/10.1016/j.jhsa.2017.05.015 CrossRef

25.

Mishra S (2001) Alternative tests in demonstrating the presence of palmaris longus. Indian J Plast Surg 34:12–14

26.

Mobarakeh MK, Pasha G, Poor M (2008) Variation, length and width of tendinous portion of palmaris longus and forearm length and height: is there a link? A cadaver study of adult Iranians. IJMS 33(3):164–168

27.

Mobin N (2016) Morphological variations and clinical applications of Palmaris longus muscle: a cadaveric study. IJDR 6(3):7144–7149

28.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

29.

Moore KL (2006) Upper limb. In: Moore KL, Dalley AF (eds) Clinically oriented anatomy, 5th edn. Lippincot Williams, Baltimore, pp 726–884

30.

Mori M (1964) Statistics on the musculature of the Japanese. Okajimas Folia Anat Jpn 40:195–300CrossRefPubMed

31.

Olewnik Ł, Wysiadecki G, Polguj M, Podgórski M, Jezierski H, Topol M (2017) Anatomical variations of the palmaris longus muscle including its relation to the median nerve—a proposal for a new classification. BMC Musculoskelet Disord 18(1):539. https://doi.org/10.1186/s12891-017-1901-x CrossRefPubMedPubMedCentral

32.

Park S, Shin Y (2008) Results of long-term follow-up observations of blepharoptosis correction using the palmaris longus tendon. Aesthet Plast Surg 32:614–619. https://doi.org/10.1007/s00266-008-9165-3 CrossRef

33.

Pushpakumar SB, Hanson RP, Carroll S (2004) The ‘two finger’ sign. Clinical examination of palmaris longus (PL) tendon. Br J Plast Surg 57:184–185CrossRefPubMed

34.

Reddy PR (2016) Prevalence of palamris longus muscle and tendon variations: a cadaveric study. IJAR 4(3):547–551

35.

Saied AR, Gheisari M, Abasi A, Ayatolahi-Mousavi A (2013) Variations of plantaris, Palmaris longus, and fifth superficial flexor tendons: a cadaveric study. J Kerman Univ Med Sci 20(1):11–19

36.

Sangiampong A, Boonkum Y (1988) Variable patterns and size of the palmaris longus muscles in Thais. Siriraj Hosp Gaz 40(7):515–519

37.

Schaeffer JP (1909) On the variations of the palmaris longus muscle. Anat Rec 3:275–278

38.

Sebastin SJ, Lim AY, Bee WH, Wong TC, Methil BV (2005) Does the absence of the palmaris longus affect grip and pinch strength? J Hand Surg Br 30(4):406–408CrossRefPubMed

39.

Simpson SL, Hertzog MS, Barja RH (1991) The plantaris tendon graft: an ultrasound study. J Hand Surg 16A:708–711. https://doi.org/10.1016/0363-5023(91)90198-K CrossRef

40.

Snell RS (2012) Clinical anatomy by regions, 9th edn. Lippincott Williams & Wilkins, Baltimore

41.

Standring S (2016) Gray’s anatomy, 41st edn. Elsevier Churchill Livingstone, Edinburg

42.

Stecco C, Lancerotto L, Porzionato A, Macchi V, Tiengo C, Parenti A, Sanudo JR, De Caro R (2009) The palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis. Clin Anat 22(2):221–229. https://doi.org/10.1002/ca.20747 CrossRefPubMed

43.

Thompson JW, McBatts J, Danforth CH (1921) Hereditary and racial variations in the musculus palmaris longus. Am J Phys Anthrop 4:205–220CrossRef

44.

Ueda K, Oba S, Okada M, Hara M, Zen N (2007) Eyelid reconstruction with a composite radial forearm palmaris longus tendon flap. J Plast Reconstr Aesthet Surg 60:256–259. https://doi.org/10.1016/j.bjps.2006.03.058 CrossRefPubMed

45.

Wehbé MA (1992) Tendon graft donor sites. J Hand Surg Am 17(6):1130–1132. https://doi.org/10.1016/S0363-5023(09)91079-6 CrossRefPubMed

46.

White WL (1960) Tendon grafts: a consideration of their source, procurement and suitability. Surg Clin N Am 40:403–413. https://doi.org/10.1016/S0039-6109(16)36047-9 CrossRefPubMed

47.

Wolfe SW (2017) Green’s operative hand surgery, 17th edn. Elsevier, Philadelphia

48.

Yammine K, Saghie S, Assi C (2019) A meta-analysis of the surgical availability and morphology of the plantaris tendon. J Hand Surg Asian Pac 24(2):208–218. https://doi.org/10.1142/S2424835519500280 CrossRef

49.

Yammine K (2013) Clinical prevalence of palmaris longus agenesis: a systematic review and meta-analysis. Clin Anat 26(6):709–718. https://doi.org/10.1002/ca.22289 CrossRefPubMed

50.

Yammine K (2014) Evidence-based anatomy. Clin Anat 27(6):847–852. https://doi.org/10.1002/ca.22397 CrossRefPubMedPubMedCentral

51.

Yao J (2012) New and emerging technology in the treatment of the upper extremity. Hand Clin 28(4):13–14. https://doi.org/10.1016/j.hcl.2012.09.001 CrossRef

Title: Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies
Authors: Kaissar Yammine
Mirela Erić
Publication date: 01-03-2020
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 3/2020
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-019-02381-x

At a glance: The STEP trials

Springer Medicine

Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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