Ultrasonographic assessment in vivo of the excursion and tension of flexor digitorum profundus tendon on different rehabilitation protocols after tendon repair

We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss. With ultrasound examination, the repaired tendons remained enlarged over 12 months. Two patients developed heterotopic ossifications at the repair site without tendon gliding, and these required tenolysis. We conclude that the tendon repair site does not gap when a strong core suture is used in the repair without adding peripheral sutures. There is no notable tendon bowstringing clinically, though the repaired tendons have sonographic evidence of minor bowstringing. Level of evidence: III

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Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420932446 ◽

2020 ◽

Vol 45 (10) ◽

pp. 1034-1044

Author(s):

Ahmed F. Sadek

Keyword(s):

Tendon Repair ◽

Flexion Contracture ◽

Flexor Digitorum Profundus ◽

Flexor Digitorum Superficialis ◽

Level Of Evidence ◽

Power Grip ◽

Contralateral Hand ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon

A total of 53 patients with complete cuts of two flexor tendons in Zone 2B treated over a 9-year period was reviewed. Twenty-three patients (28 fingers) had only flexor digitorum profundus repair, while 30 patients (36 fingers) had both flexor digitorum profundus and flexor digitorum superficialis repairs, with a mean follow-up of 21 months (range 12–84). The decision to repair the flexor digitorum superficialis was made according to intraoperative judgement of ease of repair and gliding of the flexor digitorum profundus tendon. Two groups of patients showed no significant differences in total range of active or passive digital motion and power grip percentage to the contralateral hand. However, the values of power grip were statistically superior in the patients with both tendons repaired. The patients after flexor digitorum profundus-only repairs showed significantly greater but still mild flexion contracture (mean 20 °) of the operated digits. The Tang gradings were the same with 89% good and excellent rates in both groups. The conclusion is that although repair of both flexor digitorum profundus and flexor digitorum superficialis tendons is slightly more preferable based on increased grip strength, the repair of the flexor digitorum superficialis together with flexor digitorum profundus is not mandatory. Whether or not to repair flexor digitorum superficialis is an intraoperative decision based on the ease of gliding of the repaired tendon(s). Level of evidence: III

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Isolated flexor digitorum profundus tendon injuries in zones IIA and IIB repaired with figure of eight sutures

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193410384697 ◽

2010 ◽

Vol 36 (2) ◽

pp. 147-153 ◽

Cited By ~ 8

Author(s):

M. M. Al-Qattan

Keyword(s):

Tendon Repair ◽

Suture Technique ◽

Tendon Injuries ◽

Flexor Digitorum Profundus ◽

Major Disadvantage ◽

Zone Ii ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon ◽

Tendon Laceration

The ‘figure of eight’ suture technique for flexor tendon repair is known to be simple and strong but it has the major disadvantage of being bulky, with the knots outside the repair site. When the superficialis tendon is intact it may cause impingement and/or increase the work of flexion with postoperative mobilization and it is not known whether this bulky repair is suitable for isolated profundus injuries in zone II. A series of 36 patients (36 fingers) with clean-cut isolated flexor digitorum profundus tendon injuries in zones IIA/IIB were reviewed retrospectively. Repairs were done with three ‘figure of eight’ sutures and the pulleys proximal to the tendon laceration level were vented. Postoperatively, early active exercises were carried out. There were no ruptures. At a mean final follow-up of 6 months, the outcome (in range of motion) was excellent in 27 fingers and good in the remaining nine fingers by the Strickland criteria. It was concluded that the bulky ‘figure of eight’ technique can be used in isolated profundus tendon injuries in zones IIA/IIB.

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Primary Flexor Tendon Repair in Zone 1

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1999.0319 ◽

2000 ◽

Vol 25 (1) ◽

pp. 78-84 ◽

Cited By ~ 96

Author(s):

N. S. MOIEMEN ◽

D. ELLIOT

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Flexor Digitorum Profundus ◽

Range Of Movement ◽

Realistic Assessment ◽

Distal Interphalangeal ◽

Active Mobilization ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon ◽

Distal Tendon

This paper presents an analysis of the results of repair of 102 complete flexor tendon disruptions in zone 1 which were rehabilitated by an early active mobilization technique during a 7 year period from 1992 to 1998. These injuries were subdivided into: distal tendon divisions requiring reinsertion; more proximal tendon divisions but still distal to the A4 pulley; tendon divisions under or just proximal to the A4 pulley; and closed avulsions of the flexor digitorum profundus tendon from the distal phalanx. Assessment by Strickland’s original criteria showed good and excellent results of 64%, 60%, 55% and 67% respectively in the four groups. However, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment of the affect of this injury on DIP joint function, with good and excellent results of only 50%, 46%, 50% and 22% respectively in the four groups.

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Travelling along the Clinical Roadmap: Developing Electrospun Scaffolds for Tendon Repair

Conference Papers in Science ◽

10.1155/2014/304974 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Lucy A. Bosworth

Keyword(s):

Material Properties ◽

Tendon Repair ◽

Human Mesenchymal Stem Cells ◽

Tendon Injuries ◽

Flexor Digitorum Profundus ◽

Cell Orientation ◽

Tendon Tissue ◽

Electrospun Scaffolds ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon

Biopolymers, such as poly(ε-caprolactone), can be easily electrospun to create fibrous scaffolds. It is also possible to control the alignment of the emitted fibres and further manipulate these scaffolds to create 3D yarn structures, which resemble part of the tendon tissue hierarchy. Material properties, such as tensile strength, can be tailored depending on the selection and combination of polymer and solvent used during electrospinning. The scaffolds have been proven to separately support the adhesion and proliferation of equine tendon fibroblasts and human mesenchymal stem cells whilst simultaneously directing cell orientation, which caused their alignment parallel to the underlying fibres. Implantation of scaffolds into the flexor digitorum profundus tendon of mice hindpaws yielded encouraging results with minimal inflammatory reaction and observation of cell infiltration into the scaffold. This research demonstrates the progression of electrospun fibres along the clinical roadmap towards becoming a future medical device for the treatment of tendon injuries.

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