Motion-stable flexor tendon repair with the Mantero technique in the distal part of the fingers

2009 ◽  
Vol 35 (1) ◽  
pp. 51-55 ◽  
Author(s):  
P. Schaller ◽  
W. Baer
Keyword(s):  
Distal Part ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Joint Function ◽  
Range Of Movement ◽  
Flexor Tendon Repair ◽  
Realistic Assessment ◽  
Distal Interphalangeal ◽  
Flexor Digitorum

Lacerated flexor digitorum profundus (FDP) tendons in zone 1 and distal zone 2 were reconstructed in 73 consecutive cases using the motion-stable Mantero technique during a 7-year period. Sixty-five (89%) of these patients were re-examined an average of 40 (26–82) months postoperatively. According to Moiemen and Elliot (2000) assessment by Strickland's original and modified criteria and in addition the Buck-Gramcko score showed excellent and good results of 54%, 72% and 91% respectively. In contrast, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment in DIP joint function after Mantero technique with excellent and good results of only 38%.

Primary Flexor Tendon Repair in Zone 1

2000 ◽  
Vol 25 (1) ◽  
pp. 78-84 ◽  
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.

A Modified Kleinert Controlled Mobilization Splint Following Flexor Tendon Repair

1984 ◽  
Vol 9 (2) ◽  
pp. 217-218 ◽  
Author(s):  
P. G. SLATTERY ◽  
D. A. McGROUTHER
Keyword(s):  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Normal Range ◽  
Flexor Tendon Repair ◽  
Distal Interphalangeal ◽  
Flexor Digitorum

The Controlled Mobilization Splint as described by Kleinert for use following flexor tendon repair has been modified to more closely simulate the normal range of motion of the fingers and in particular to increase the range of motion at the distal interphalangeal joint and so enhance the relative gliding of the flexor digitorum superficialis and flexor digitorum profundus tendons and hence possibly to reduce potential intertendinous adhesions.

Flexor Tendon Repair Using a Stainless Steel Internal Anchor

1998 ◽  
Vol 23 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. GORDON ◽  
M. TOLAR ◽  
K. T. VENKATESWARA RAO ◽  
R. O. RITCHIE ◽  
S. RABINOWITZ ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Active Range Of Motion ◽  
Flexor Digitorum

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99–270% increase in mean maximal linear tensile strength and a 49–240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Simplifying four-strand flexor tendon repair using double-stranded suture: a comparative ex vivo study on tensile strength and bulking

2012 ◽  
Vol 37 (2) ◽  
pp. 101-108 ◽  
Author(s):  
T. H. Low ◽  
T. S. Ahmad ◽  
E. S. Ng
Keyword(s):  
Tensile Strength ◽  
Flexor Tendon ◽  
Ex Vivo ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Significant Difference ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Flexor Digitorum

We have compared a simple four-strand flexor tendon repair, the single cross-stitch locked repair using a double-stranded suture (dsSCL) against two other four-strand repairs: the Pennington modified Kessler with double-stranded suture (dsPMK); and the cruciate cross-stitch locked repair with single-stranded suture (Modified Sandow). Thirty fresh frozen cadaveric flexor digitorum profundus tendons were transected and repaired with one of the core repair techniques using identical suture material and reinforced with identical peripheral sutures. Bulking at the repair site and tendon–suture junctions was measured. The tendons were subjected to linear load-to-failure testing. Results showed no significant difference in ultimate tensile strength between the Modified Sandow (36.8 N) and dsSCL (32.6 N) whereas the dsPMK was significantly weaker (26.8 N). There were no significant differences in 2 mm gap force, stiffness or bulk between the three repairs. We concluded that the simpler dsSCL repair is comparable to the modified Sandow repair in tensile strength, stiffness and bulking.

Comparison of the Mechanical Properties of Polyglycolide-Trimethylene Carbonate (Maxon) and Polydioxanone Sutures (PDS2) used for Flexor Tendon Repair and Active Mobilization

2002 ◽  
Vol 27 (4) ◽  
pp. 329-332 ◽  
Author(s):  
A. WADA ◽  
H. KUBOTA ◽  
M. TAKETA ◽  
H. MIURA ◽  
Y. IWAMOTO
Keyword(s):  
Mechanical Properties ◽  
Tensile Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Trimethylene Carbonate ◽  
Flexor Tendon Repair ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Observation Period

Thirty-six canine flexor digitorum profundus tendons were repaired using 5-0 polyglycolide-trimethylene carbonate monofilament (Maxon) or polydioxanone monofilament (PDS2). All the tendons healed without rupture or formation of gaps of more than 2 mm. Mechanically, all tendon repairs had sufficient tensile strength to enable active mobilization. Polyglycolide-trimethylene carbonate (Maxon) repairs were initially superior in gap and ultimate strength to polydioxanone (PDS2) repairs. However, the gap and ultimate tensile strength of polyglycolide-trimethylene carbonate (Maxon) repairs had decreased significantly at day 14, whereas polydioxanone (PDS2) repairs maintained their strength throughout the 28-day observation period.

Biomechanical investigation of uneven load bearing in six-strand Lim-Tsai flexor tendon repair using FiberLoop®

2016 ◽  
Vol 42 (5) ◽  
pp. 457-461 ◽  
Author(s):  
R.A.S. Hay ◽  
Y.R. Wong ◽  
A.M. Loke ◽  
S.C. Tay
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Load Bearing ◽  
Biomechanical Investigation ◽  
Flexor Digitorum ◽  
Biomechanical Strength

We hypothesized that, in providing biomechanical strength, at least one of the two middle strands in a modified six-strand Lim-Tsai flexor tendon repair could be divided without obvious reduction in repair strength owing to uneven load bearing. A total of 40 porcine flexor digitorum profundus tendons were repaired using the six-strand Lim-Tsai technique with a 4-0 FiberLoop® suture and then divided into four equal groups. (no cut, one middle strand cut, both middle strand cut, one side strand cut). The biomechanical performance of repaired tendons was tested and found to vary according to the location of the cuts.

In vivo flexor tendon forces generated during different rehabilitation exercises

2015 ◽  
Vol 40 (7) ◽  
pp. 705-710 ◽  
Author(s):  
S. Edsfeldt ◽  
D. Rempel ◽  
K. Kursa ◽  
E. Diao ◽  
L. Lattanza
Keyword(s):  
Flexor Tendon ◽  
Controlled Trial ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Neutral Position ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Finger Flexion ◽  
Flexor Digitorum

We measured in vivo forces in the flexor digitorum profundus and the flexor digitorum superficialis tendons during commonly used rehabilitation manoeuvres after flexor tendon repair by placing a buckle force transducer on the tendons of the index finger in the carpal canal during open carpal tunnel release of 12 patients. We compared peak forces for each manoeuvre with the reported strength of a flexor tendon repair. Median flexor digitorum profundus force (24 N) during isolated flexor digitorum profundus flexion and median flexor digitorum superficialis force (13 N) during isolated flexor digitorum superficialis flexion were significantly higher than during the other manoeuvres. Significantly higher median forces were observed in the flexor digitorum superficialis with the wrist at 30° flexion (6 N) compared with the neutral wrist position (5 N). Median flexor digitorum profundus forces were significantly higher during active finger flexion (6 N) compared with place and hold (3 N). Place and hold and active finger flexion with the wrist in the neutral position or tenodesis generated the lowest forces; isolated flexion of these tendons generated higher forces along the flexor tendons. Level of evidence: III (controlled trial without randomization)

Vascularized dorsal digital fascial flap improves flexor tendon repairs

2013 ◽  
Vol 39 (7) ◽  
pp. 714-718 ◽  
Author(s):  
L.-Q. Sun ◽  
G. Zhao ◽  
S.-H. Gao ◽  
C. Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Distal Interphalangeal Joint ◽  
Flexor Tendon Repair ◽  
Fascial Flap ◽  
Group A ◽  
Distal Interphalangeal ◽  
Zone Ii ◽  
Group B ◽  
Flexor Digitorum

We report a new method of flexor tendon repair in zone II using a standard modified Kessler technique combined with a vascularized dorsal fascial flap from the finger pedicled on a dorsal cutaneous branch of the proper digital artery, which is placed as a mechanical barrier between the flexor digitorum superficialis and profundus tendons. The functional outcomes of 14 patients (Group A) with flexor tendon repairs in zone II by this new technique were compared with those of 32 patients (Group B) with flexor tendon repairs in zone II using a standard modified Kessler technique only. Patients in Group A had a higher proportion of excellent results (on the modified Strickland system) and more movement in the distal interphalangeal joint than the patients in Group B.

A2 PULLEY INTEGRITY AND THE STRENGTH OF FLEXOR TENDON REPAIR: A BIOMECHANICAL STUDY IN A CHICKEN MODEL

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 11-17 ◽  
Author(s):  
Marc J. Langbart ◽  
Constantine M. Glezos ◽  
Belinda J. Smith ◽  
Elizabeth C. Clarke ◽  
Richard D. Lawson ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Flexor Tendon Repair ◽  
Pull Out ◽  
A2 Pulley ◽  
Distal Interphalangeal ◽  
Joint Flexion

Purpose: This study assesses the influence of A2 pulley integrity on the strength of the repair. Method: Part 1- The flexor digitorum profundus (FDP) tendons of 72 Cobb chicken feet were severed and repaired in the region of the A2 pulley using a modified Kessler core suture and an epitendinous suture. The A2 pulley was either left intact, divided for 50% of its length, or divided in its entirety. The distal interphalangeal joint was fixed at a position of 20°, 40° or 60° of joint flexion. The load to failure, integrity of the A2 pulley and the site of tendon failure were analysed. Part 2- A further 32 chicken feet were used to exclude the effects of freezing and thawing on results and to analyse differences when using a core suture only. Results: No difference in failure load between any of the test groups or subgroups was identified. The integrity of the A2 pulley was preserved in all specimens. The most common cause of failure was distal suture pull-out. Discussion: This study does not demonstrate that release of the A2 pulley provides an advantage in increasing tendon repair strength. Division of 50% of the A2 pulley does not predispose to pulley rupture. Flexor tendon repair strength did not alter with distal interphalangeal joint flexion between 20° and 60°. Clinical Relevance: The findings of this study do not support division of the A2 pulley to prevent flexor tendon repair failure if repair methods of appropriate strength are utilised.

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