Total Anterior Tenoarthrolysis to Treat Inveterate Flexion Contraction of the Fingers: A Series of 16 Patients

Abstract

Total anterior tenoarthrolysis was originally described by Saffar to treat flexion contractions of the fingers. This procedure consists of releasing the entire flexor apparatus and the interphalangeal volar plates through a lateral incision and a volar subperiosteal dissection. The anterior flap slides proximally in relation to the bone, leaving a pulpar defect. To maintain the digital pulp intact, we proposed advancing the volar flap and transposing the defect at the base of the finger. A series of 16 patients who underwent total anterior tenoarthrolysis are presented; 6 patients underwent surgery according to our modification. Postoperative range of motion was improved in 11 of 16 patients and correlated with subjective patient appreciation. Fingers that had a preoperative interphalangel total active motion greater than 55 degrees were significantly improved. No improvement was seen among patients with stiff, crooked fingers. The average total extension deficit decreased from 33 degrees at the proximal interphalangeal joint level and 6 degrees at the distal interphalangeal joint level. Total anterior tenoarthrolysis is considered a salvage procedure to treat flexion contractures of the fingers with articular cartilages that are in good condition and tendons that are still working.