Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2026
In-silico biomechanical simulation of tendon transfers for finger extension in radial nerve palsy.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Lee B W, Hong W K, Hwang J S, Kim K S, Gong H S
Аннотация
BACKGROUND: Tendon transfers are commonly used to restore finger extension in patients with radial nerve palsy, but quantitative comparisons of different techniques remain limited. Achieving the correct tension continues to be a surgical art, guided more by experience than by objective standards. In-silico biomechanical simulation may serve as a valuable tool to evaluate and optimize tendon transfer strategies in a more reproducible and quantitative manner.
METHODS: We used OpenSim software to simulate four tendon transfers targeting the extensor digitorum communis (EDC): flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), 4th flexor digitorum superficialis (FDS), and combined 3rd/4th FDS. Tendon paths were modeled to reflect surgical anatomy, and post-transfer tension was adjusted to maintain each donor tendon's native tension. We also proposed optimal tensioning, defined as the overlap length allowing maximal actin-myosin contraction. Metacarpophalangeal (MCP) joint extension moments were compared before and after applying the calculated optimal overlap lengths.
RESULTS: At maximum MCP extension, FCU, FCR, and 3rd/4th FDS restored 77.1%, 75.0%, and 75.8% of the original EDC moment, respectively (4th FDS alone: 30.7%). After applying optimal overlap lengths (4.3 mm for FCR, 14.1 mm for FCU, and 9.8 mm for FDS), extension moments increased to 88.0% for FCU, 79.9% for 3rd/4th FDS, 76.6% for FCR, and 32.1% for 4th FDS.
CONCLUSIONS: FCU was the most effective donor tendon, especially after tension optimization. In-silico simulation enables objective comparisons and may guide intraoperative tensioning. Further validation in cadaveric or clinical settings is warranted.
LEVEL OF EVIDENCE: Level of Evidence: V, Biomechanical Study.
METHODS: We used OpenSim software to simulate four tendon transfers targeting the extensor digitorum communis (EDC): flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), 4th flexor digitorum superficialis (FDS), and combined 3rd/4th FDS. Tendon paths were modeled to reflect surgical anatomy, and post-transfer tension was adjusted to maintain each donor tendon's native tension. We also proposed optimal tensioning, defined as the overlap length allowing maximal actin-myosin contraction. Metacarpophalangeal (MCP) joint extension moments were compared before and after applying the calculated optimal overlap lengths.
RESULTS: At maximum MCP extension, FCU, FCR, and 3rd/4th FDS restored 77.1%, 75.0%, and 75.8% of the original EDC moment, respectively (4th FDS alone: 30.7%). After applying optimal overlap lengths (4.3 mm for FCR, 14.1 mm for FCU, and 9.8 mm for FDS), extension moments increased to 88.0% for FCU, 79.9% for 3rd/4th FDS, 76.6% for FCR, and 32.1% for 4th FDS.
CONCLUSIONS: FCU was the most effective donor tendon, especially after tension optimization. In-silico simulation enables objective comparisons and may guide intraoperative tensioning. Further validation in cadaveric or clinical settings is warranted.
LEVEL OF EVIDENCE: Level of Evidence: V, Biomechanical Study.