Year: 2025 | Month: July | Volume: 12 | Issue: 7 | Pages: 10-22
DOI: https://doi.org/10.52403/ijrr.20250702
Tendon Transfer for Radial Nerve Palsy: A Systematic Review and Meta-Analysis of Functional Outcomes, Timing, and Complications
Kadek Riyandi Pranadiva Mardana1, Made Bramantya Karna2
1Resident, Dept. Orthopaedic & Traumatology, Prof IGNG Ngoerah General Hospital, Udayana University, Bali, Indonesia
2Orthopaedic Surgeon, Dept. Orthopaedic & Traumatology, Prof IGNG Ngoerah General Hospital, Udayana University, Bali, Indonesia
Corresponding Author: Kadek Riyandi Pranadiva Mardana
ABSTRACT
Background: Tendon transfer is a key surgical technique for restoring hand and wrist function in radial nerve palsy, particularly when nerve recovery is unlikely. However, the optimal timing for surgery remains debated. This meta-analysis evaluates the impact of early (<12 months) vs. late (>12 months) tendon transfer on motor recovery, wrist function, and revision rates.
Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library identified seven studies. Statistical analysis was performed using Review Manager 5.4.1 and R Studio. A random-effects model was applied to calculate risk ratios (RR) and proportions with 95% confidence intervals (CI). Heterogeneity was assessed using I², and risk of bias was evaluated with ROBINS-I.
Results: Early tendon transfer significantly improved complete motor recovery (RR = 2.40, 95% CI: 1.26–4.55, P = 0.008), with low-to-moderate heterogeneity (I² = 29%). Wrist flexion limitation showed no significant difference between early and late surgery (RR = 1.23, 95% CI: 0.50–3.01, P = 0.66, I² = 34%). Functional outcomes measured by DASH scores showed no statistically significant difference between tendon transfer and non-tendon transfer approaches (Mean Difference = -2.92, 95% CI: -12.65 to 6.82, P = 0.56, I² = 0%), though a trend toward improved function with tendon transfer was observed. Revision surgery occurred in 20% of cases (95% CI: 4%–37%), with low heterogeneity (I² = 0%).
Conclusions: Early tendon transfer significantly improves motor recovery, supporting its role as the preferred approach. However, timing does not affect wrist flexion limitation, suggesting that rehabilitation protocols influence outcomes. The 20% revision rate highlights the need for careful patient selection and surgical planning. Future studies should explore snerve transfers, regenerative medicine, and long-term functional outcomes.
Keywords: Radial nerve palsy, tendon transfer, early surgery, motor recovery, revision surgery, meta-analysis
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