Sonographic study of repair, gapping and tendon bowstringing after primary flexor digitorum profundus repair in zone 2

2018 ◽  
Vol 43 (5) ◽  
pp. 480-486 ◽  
Author(s):  
Lisa Reissner ◽  
Nadja Zechmann-Mueller ◽  
Holger Jan Klein ◽  
Maurizio Calcagni ◽  
Thomas Giesen
Keyword(s):  
Clinical Outcomes ◽  
Ultrasound Examination ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Repair Site ◽  
Heterotopic Ossifications ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

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

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

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

Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers

2019 ◽  
Vol 44 (4) ◽  
pp. 361-366 ◽  
Author(s):  
Zhang Jun Pan ◽  
Yun Fei Xu ◽  
Lei Pan ◽  
Jing Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Repair Site ◽  
The Core ◽  
Active Flexion ◽  
Flexor Digitorum

We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8–33 months. We conclude that tensioned multi-strand strong core repairs only require sparse peripheral stitches and are safe for early active flexion. Standard peripheral sutures are not necessary. The core sutures should be properly tensioned to prevent gapping at tendon repair site and pulleys should be sufficiently vented to allow tendon motion. Level of evidence: IV

Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion

2018 ◽  
Vol 43 (5) ◽  
pp. 474-479 ◽  
Author(s):  
Thomas Giesen ◽  
Lisa Reissner ◽  
Inga Besmens ◽  
Olga Politikou ◽  
Maurizio Calcagni
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Level Of Evidence ◽  
Active Motion ◽  
Post Surgery ◽  
A2 Pulley ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half. When the flexor digitorum profundus tendon would not glide under the A2 pulley, we excised the remaining slip of the flexor digitorum superficialis tendon. The wrist was splinted in mild extension post-surgery with early commencement of tenodesis exercises. No tendon repair ruptured. By the Strickland criteria, out of 27 fingers, 18 had excellent, six had good, two had fair, and one had poor results. We conclude that a strong core suture (such as the M-Tang repair) without peripheral sutures, and with division of pulleys as necessary is safe for early active motion and yields good outcomes. Level of evidence: IV

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

2010 ◽  
Vol 36 (2) ◽  
pp. 147-153 ◽  
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.

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.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
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.

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

2017 ◽  
Vol 43 (5) ◽  
pp. 487-493 ◽  
Author(s):  
Aude Bommier ◽  
Duncan McGuire ◽  
Patrick Boyer ◽  
Asan Rafee ◽  
Sami Razali ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

We report outcomes of reconstruction of zone 1 or 2 flexor tendon injuries using a heterodigital hemi-tendon transfer of the flexor digitorum profundus in 23 fingers of 23 patients. At mean follow-up of 57 months, the mean total active motion of the three finger joints including the metacarpophalangeal joint was 128 degrees preoperatively and 229 degrees at final follow up. According to Strickland criteria, the function was excellent for 14 fingers, good for seven fingers and poor for two fingers. The subgroup analysis showed that the results were better in cases of primary surgery, children, and for the index and little fingers. Complications included stiffness of three fingers, and rupture in one finger that was converted to a two-stage tendon reconstruction. We conclude that this technique restores good function in most patients with zone 1 and 2 flexor tendon injuries, in which primary tendon repair has not been performed or was unsuccessful, and where pulley reconstruction is not required. Level of evidence: IV

A knotless bidirectional-barbed tendon repair is inferior to conventional 4-strand repairs in cyclic loading

2016 ◽  
Vol 41 (8) ◽  
pp. 809-814 ◽  
Author(s):  
F. P. O’Brien ◽  
B. G. Parks ◽  
M. A. Tsai ◽  
K. R. Means
Keyword(s):  
Cyclic Loading ◽  
Tendon Repair ◽  
Suture Technique ◽  
Flexor Digitorum Profundus ◽  
Barbed Suture ◽  
Suture Repair ◽  
Level Of Evidence ◽  
Active Range Of Motion ◽  
Suture Group ◽  
Flexor Digitorum

We divided 21 flexor digitorum profundus tendons in the index, middle and ring fingers in seven cadaver hands into three groups. The tendons were cut in zone 2 and repaired using a 4-strand cruciate core suture repair with one of the following three materials in each group: (1) a knotless repair with a 2-0 bidirectional-barbed suture, which has similar tensile strength as a 4-0 non-barbed suture used in the other two groups; (2) a knotted locking repair with a non-barbed 4-0 conventional suture; and (3) a non-locking repair with a non-barbed 4-0 knotless suture. The repaired fingers were cyclically loaded through a simulated active range of motion to a 5 N load. We monitored and recorded the gap sizes at regular intervals during the test. The 2-0 bidirectional-barbed suture group and non-barbed suture groups developed gaps of 2.2 mm after 10 cycles and 2.4 mm after 20 cycles, respectively. Over 1000 cycles, the mean gaps were 3.2 mm in the 4-0 conventional suture group and 9.1 mm in the 2-0 bidirectional-barbed group. The tendons in the 2-0 bidirectional-barbed group gapped earlier, with statistically significant differences compared with those in the locking repair with a non-barbed 4-0 knotless suture group. The repair strength of the barbed suture technique was inferior to the cruciate repairs using a conventional 4-0 non-barbed suture tested in this cyclic-loading model. Level of evidence: Level V

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