Deep Flexor Tendon Research Articles

Acute carpal tunnel syndrome after atraumatic rupture of the flexor tendons: a case report

Acute carpal tunnel syndrome (ACTS) is a rare entity, mainly associated with traumatic causes, although patients with predisposing factors such as taking anticoagulants or tendinopathies may debut with an atraumatic ACTS. This case study presents the case of a 77-year-old male patient, anticoagulated, who began with rapidly progressive pain and swelling in the right wrist, radiating towards the medial territory, with no history of traumatic triggering event. Examination showed paraesthesia in the volar aspect of the first to third fingers of the hand and increased pain on passive mobilisation of the fingers. Given the progressive evolution of the condition and the lack of response to both physical and pharmacological measures, the carpal tunnel was opened surgically. During surgery, a significant haematoma was observed secondary to the rupture of the deep flexor tendons of the fourth and fifth fingers inside the canal. Following release of the carpal tunnel, complete recovery of the symptomatology occurred. In conclusion, a high degree of clinical suspicion is necessary in a patient with an examination suggestive of ACTS. The treatment of choice is urgent surgical decompression of the carpal tunnel. Early intervention allows resolution of symptoms and reduces complications.

Surgical treatment of children with tendon injuries of deep finger flexor tendons in the zone of fibrosynovial canals in pediatric patients: a review

Surgical treatment of children with tendon injuries of deep finger flexor tendons in the zone of fibrosynovial canals in pediatric patients: a review

Flexor Tendon Grafting as Reoperative Procedure for Injuries within Fingers and Thumb

Background. The reoperation rate reported in the literature in cases of flexor tendon injuries within the fingers and thumb is about 20%, but the functional results of these reoperations are barely discussed.
 The aim of the study was to evaluate the results of flexor tendon grafting performed as a redo procedure in patients who had previously underwent unsuccessful flexor tendon surgery.
 Methods. This study reports the outcomes of deep flexor tendon and flexor pollicis longus tendon grafting in 122 fingers of 109 patients depending on two factors — the type of the first failed surgery (tendon suture in 51 fingers vs grafting in 71 fingers) and the type of the medical unit where the failed procedure had been performed (hand surgery department in 76 cases vs general trauma unit in 46 cases).
 Results. Our reoperative grafting procedures led to excellent results in 13 fingers of 51 (25.5% [95% CI: 14–40]) after failed tendon suture and in 32 fingers of 71 (45.1% [95% CI: 33–57]) after failed previous grafting, difference is statistically significant (÷2 = 4.888; p = 0.027). Failed surgeries performed at the hand surgery departments were redone with 48.7% [95% CI: 37–60] of excellent results (in 37 fingers of 76) and 14.5% [95% CI: 7–24] of fair results (in 11 fingers of 76). Failed surgeries performed at the general trauma units were redone with 17.4% [95% CI: 8–31] of excellent results (in 8 fingers of 46). This value statistically significantly differed from the hand surgery departments group: ÷2 = 12.054; p = 0.001. For a total, excellent results were obtained in 36.9% [95% CI: 28–46] (in 45 fingers of 122) of reoperative grafting procedures and good results in 34.5% [95% CI: 26–43] (in 42 fingers of 122).
 Conclusions. Analysis of the functional results of deep flexor tendon and flexor pollicis longus tendon grafting performed as a reoperative procedure showed that the excellent results with full finger function were achievable in patients who had previously undergone unsuccessful flexor tendon surgery in zone 2. But in general, the rates of motion recovery were significantly lower than in uncomplicated cases, even with a long history of injury. The worst functional results of reoperations were in patients who had previously been unsuccessfully operated in non-specialized medical units.

The aetiology of fracture and nonunion in the hook of the hamate.

Fractures of the hook of the hamate are traditionally thought to be caused by direct trauma. A review of the anatomy and function of the hamate hook suggests that fracture is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons. Additional vascular compromise, from direct pressure of the tendons on critical local vessels, reduces blood flow leading to both mechanical and vascular effects that create pathological osseous change and weakening. These changes are likely to predispose to stress fracture and nonunion in repetitive gripping activities and are consistent with radiological findings.

Minimally Invasive Suture Technique Pull-out to Repair the Acute Flexor Tendons in Zone II of the Hand.

Objective: To evaluate the safety and effectiveness of a modified pull-out suture technique in patients undergoing primary repair surgery for injuries to the flexor tendons of the fingers with Total Active Motion (TAM) as the primary outcome. Method: A total of 29 patients (38 fingers) were chosen from both sexes, aged between 18 and 65 years with clean acute tendon laceration occurring within 15 days, in the Verdan's zone II of flexor tendon in the hand, when only the deep flexor tendon was sutured, either associated or not with digital nerve injury. The patients were operated on using the proposed technique and evaluated at 3, 9 and 24-weeks PO. The primary outcome was the assessment of Total Active Movement (TAM) and 3 classifications were employed: Strickland, IFSSH and Buck-Gramcko. Results: We observed a total active motion (TAM) of 209.3 °at the end of 24 weeks; 83.0% of Good and Excellent results by the Modified Strickland Classification, 93% of Excellent results by the IFSSH Classification, and 97% of Good and Excellent results using the Buck-Gramcko Classification. There were no cases of rupture, but tendon adhesion was observed in 3 fingers. Conclusion: The present suture technique proved to be safe and effective with a low rate of complications, obtaining an excellent functional result in terms of total active mobility, according to the evaluations and classifications used.

Biomechanical evaluation of the ST-knot: A new suture for flexor tendon repair

PurposeAlthough tendon lacerations are common, there is currently no consensus on choice of suture. Easy and fast sutures that impart enough strength to allow mobilization are needed. This study compared the ex vivo biomechanical strength (force required to create a 2 mm tendon gap) of a novel suture (ST-knot) with that of a conventional suture (double Kessler). Materials and methodsForty fresh deep flexor tendons from porcine forelimbs were used. Both repaired tendon ends were mounted on standard traction jaws of an axial traction machine at an initial distance of 40 mm for all tendons. A high-definition camera was used to determine the force forming a 2 mm gap. Ten tendons in group 1 (ST-knot) and 10 in group 2 (double Kessler) were prepared with PDS 4.0 (single thread for Kessler, double thread for ST-knot). Tendons in groups 3 (ST-knot) and 4 (double Kessler) were repaired with PDS 1.0 using the same principle. ResultsThere was no significant difference in the force required to form a 2 mm tendon gap between groups 1 and 2, and this trend was identical when using a stronger thread in groups 3 and 4. The maximum force before rupture, mode of repair failure, stress and stiffness were also comparable, with no significant differences between groups 1 and 2, or between groups 3 and 4. ConclusionsThe ST-knot showed comparable results to the double-Kessler knot, whichever the thread used. Because it involves fewer steps than conventional techniques and is easy to perform, the ST-knot may offer a therapeutic solution, particularly in complex trauma with multiple tendon injury.

Joint Stress Analysis of the Navicular Bone of the Horse and Its Implications for Navicular Disease.

The horse's navicular bone is located inside the hoof between the deep flexor tendon (DDFT) and the middle and end phalanges. The aim of this study was to calculate the stress distribution across the articular surface of the navicular bone and to investigate how morphological variations of the navicular bone affect the joint forces and stress distribution. Joint forces normalised to the DDFT force were calculated from force and moment equilibria from morphological parameters determined on mediolateral radiographs. The stress distribution on the articular surface was determined from the moment equilibrium of the stress vectors around the centre of pressure. The ratio of the proximal to the distal moment arms of the DDFT, as well as the proximo-distal position and extent of the navicular bone, individually or in combination, have a decisive influence on the position and magnitude of the joint force and the stress distribution. If the moment arms are equal and the bone is more proximal, the joint force vector originates from the centre of the joint surface and the joint load is evenly distributed. However, in a more distal position with a longer distal moment arm, the joint force is close to the distal edge, where the joint stress reaches its peak. Degenerative navicular disease, which causes lameness and pathological changes in the distal portion of the bone in sport horses, is likely to be more severe in horses with wedge-shaped navicular bones than in horses with square bones.

Short-Term and Long-Term Therapeutic Results of Deep Flexor Tendon Repair in Zone II in Patients Referred to Imam Khomeini Hospital, Ahvaz, Southern Iran.

Hand injury as an important concern for the surgeon and the patient requires proper and timely treatment to prevent complications such as infection and adhesions, and with a proper rehabilitation program, the patient returns to maximum function as soon as possible. We aimed to investigate the short-term and long-term treatment results of deep flexor tendon repair in in zone II. This retrospective study was performed on 34 patients with 45 injured fingers in the zone II referred to Ahvaz Imam Khomeini Hospital, Ahvaz, Iran during 2017-2019. The results of deep flexor tendons repair in two groups, immediate and delayed primary repair were assessed. The mean age of the patients was 27.76 years. There was no significant remarkable between male and female in the incidence of complications such as infection, tendon rupture and adhesions. 29.4% (n=10) had poor outcome, 8.8% (n=3) had fair outcome, 29.4% (n=10) had good outcome and 32.4% (n=11) had excellent outcomes. 26.5% had adhesion and infection rate was 11.8%. Among surgeons, there is consensus for the primary repair of tendon injury, but there was no significant difference between the results of immediate and delayed primary repair. Although physiotherapy has been suggested as an effective factor in improving hand function, its positive effect on the range of motion of the fingers has not been proven.

Ultrasonography Enthesitis and Synovitis Screening in Psoriatic Patients: A Case Control Study.

The clinical screening of enthesitis and synovitis in patients with psoriasis lacks specificity and sensitivity during the preclinical phase. to assess US subclinical synovitis and enthesitis in psoriatic patients compared with healthy controls. A cross-sectional study on 40 psoriatic patients and 40 healthy sex- and age-matched controls. US examination of 18 joints was performed along with 22 entheseal sites on the upper and lower limbs. US subscores were established according to the US abnormalities: inflammatory score (tendon thickening, hypoechogenicity, bursitis, Doppler signal), damage score (calcification, enthesophytes, bone erosion) and total score (the sum of inflammatory and damage scores). US synovitis were more frequent in psoriatic patients (0.68%) than in controls (0.29%), but the difference was not significant. Patients with psoriasis had more US enthesitis (92,5%) compared to controls (40%)(p<0.001). The total number of enthesitis was higher in the psoriatic group (20.90%) compared to controls (4,78%)(p<0.001). There were more US abnormalities in the psoriatic group compared to controls for calcaneal tendon enthesis(p<0.001), distal patellar tendon enthesis(p<0.001) and deep flexor tendons of the finger enthesis(p<0.001). Compared to controls, psoriatic patients had a significantly higher inflammatory score (Mean±SD) (2.85±3.34 versus 0.58±1.17), damage score (3±2.57 versus 0.60±1.41), and total score (5.85±5.20 versus 1.18±2.07) (p < 0.001 each). Patients with scalp psoriasis had more US enthesitis (p=0.020). Our results indicate that US enthesitis and synovitis are more frequent in patients with psoriasis. Prospective studies with larger sample size are needed to define the contribution of US in predicting the clinical onset of PsA.

РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ЗАСТАРЕЛЫХ ПОВРЕЖДЕНИЙ СУХОЖИЛИЙ СГИБАТЕЛЕЙ ПАЛЬЦЕВ КИСТИ В КОСТНО-ФИБРОЗНЫХ КАНАЛАХ

Background. Restoration of finger flexor tendons in fibro-osseous canals in the long term after injury is a difficult task due to scarring blockage and the impossibility of early active rehabilitation. Therefore, it is important to develop methods for durable tendon reconstruction that can provide early rehabilitation of patients without the risk of rupture of the suture zone. Aim. To evaluate the clinical effectiveness of surgeries on the flexor tendons of fingers in case of chronic injuries in fibro-osseous canals with the creation of strong connections in the sutured zone. Material and methods. The study included 66 patients with chronic injuries of 104 flexor tendons in fibro-osseous canals of the fingers. The main group consisted of 29 patients who underwent restoration of 47 tendons using new methods within 3 to 11 weeks after injury: subgroup A included 23 cases of reconstruction of the deep flexor tendon with a hidden transosseous suture in zone I; subgroup B included 24 sutures with isolation with dissected polymeric tube in zone II. Control group included 37 patients with tendon injuries on 49 fingers within fibro-osseous canals with injury term from 3 weeks to 30 years who underwent classical surgeries: secondary flexor digitorum profundus suture on 31 fingers, 2-stage tendoplasty – on 13, distal phalanx tenodesis – on 4 and reinsertion by Bunnell – on 1 finger. Also, as a control, 8 fingers were evaluated in 7 patients of the main group on which 4 secondary sutures, 2 tendoplasties and 2 tenodeses were performed. Finger function was determined by J.W. Strickland before 3, 6 months and 1 year after surgery, qualitative parameters were analyzed using two-tailed Fisher's exact test. Hand function was evaluated using the DASH questionnaire before surgery and 1 year later, the significance of differences was checked using the Mann-Whitney U-test. Results. The use of durable tendon reconstruction methods in patients of the main group enables to obtain results on average in 3 months similar to the results of 2-stage tendoplasty 10-12 months after the start of treatment in the control group. The results of reinsertion with a hidden transosseous suture and suture with temporary isolation with dissected polymer tubes did not differ significantly in terms of the degree of range of motion recovery and hand function assessment by patients. Conclusions. The developed methods showed better results in restoring the function of the fingers in comparison with classical surgeries. A strong tendon connection combined with an early start of movement increases the number of good and excellent functional outcomes and ensures patients’ satisfaction with treatment results.

Giant Lipoma of the Hand: An Exceedingly Rare Condition!

Lipomas are the most common benign form of soft tissue tumor in the body. Although they are commonly found on the upper extremity, their occurrence in the hand is rare. Giant lipomas of the hand, defined as &gt;5 cm in diameter, are extremely rare. This manuscript reports a very rare case of giant lipoma on the palmar side of the hand in order to study the diagnostic, theurapeutic and prognostic aspects. A 61 year-old female had a large asymptomatic thenar swelling since 10 years. The clinical examination showed a subcutaneous tumor spreading the 1st commissure and making opposition of the thumb very limited. There were no inflammatory signs and no pain. The patient didn’t report any sensory deficit and the neurological examination was normal. The standard X-ray showed a tissue image without bone lesions. MRI demonstrated a large, well-limited T1, T2 hypersignal tissue formation, which developed in the subcutaneous fat of the first commissure, insinuated itself in front of the last three metacarpals, and included the deep and superficial flexor tendons. The patient was operated on under local anesthesia and pneumatic tourniquet at the root of the limb. The approach allowed a satisfactory exposure of the entire palm of the hand and revealed a lipomatous mass, encapsulated, pushing back the vascular and neural pedicles of the long fingers without invading them and remaining in front of the flexor tendons. The tumor was carefully dissected, which allowed it to be removed totally. Histology confirmed the diagnosis of benign lipoma. Complete recovery was achieved without any sign of recurrence during a follow up period of 5 years. Lipomas of the hand represent a rare benign tumor pathology; giant lipomas represent an exceedingly rare condition. The proximity of the relationships with the vascular and neural structures must lead to the greatest caution during surgical dissection. Only anatomopathological examinations confirm the histological nature of the lesion.

Comparaison des différentes ancres dans les réinsertions transosseuses de tendons fléchisseurs profonds en zone I

Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use. This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score. The average age was 38.6 years (±16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH. Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Comparison of Six-strand and Four-strand Techniques on the Repair of Injured Deep Flexor Tendons of Zone II of the Hand: A Randomized Controlled Clinical Trial

Comparison of Six-strand and Four-strand Techniques on the Repair of Injured Deep Flexor Tendons of Zone II of the Hand: A Randomized Controlled Clinical Trial

Ultrasound Morphometry and Mean Echogenicity of Digital Flexor Tendons, Suspensory Ligament, and Accessory Ligament of Digital Deep Flexor Tendon in Gaited Horses.

The objective of this study was to evaluate and compare the sonographic characteristics of the digital flexor tendons and ligaments of the palmar/plantar of the metacarpal and metatarsal regions in gaited horses, as well as to establish normal reference ultrasound values for Mangalarga Marchador (MM) and Campeiro breeds. Transverse sonographic images were obtained of 50 adult and healthy horses from the MM (n = 25) and Campeiro (n = 25) breeds. The images were taken in six metacarpal/metatarsal zones, and the following measurements were taken: transverse area, circumference, dorsopalmar/plantar length, lateromedial length, and mean echogenicity. Differences were observed between breeds in the fore- and hindlimbs, and, even when not significant, the Campeiro breed tended to have higher values for most variables and structures. Variations between zones and between structures in the same zone followed a similar trend in both breeds for all variables. In addition, the dimensions and variations between zones and structures were different between the fore- and hindlimbs, highlighting the need for specific values for the digital flexor tendons and ligaments of the metatarsal plantar region. In conclusion, the digital flexor tendons, suspensory ligaments, and accessory ligaments of the digital deep flexor tendon are influenced by the breed factor in gaited horses, and they are different between the fore- and hindlimbs.

Interference screws manufactured from magnesium display similar primary stability for soft tissue anterior cruciate ligament graft fixation compared to a biocomposite material – a biomechanical study

PurposeBiodegradable interference screws (IFS) can be manufactured from different biomaterials. Magnesium was previously shown to possess osteoinductive properties, making it a promising material to promote graft-bone healing in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare IFS made from magnesium to a contemporary biocomposite IFS.MethodsIn a porcine model of ACL reconstruction, deep porcine flexor tendons were trimmed to a diameter of 8 mm, sutured in Krackow technique, and fixed with either 8 × 30 mm biocomposite IFS (Bc-IFS) or 8 × 30 mm magnesium IFS (Mg-IFS) in an 8 mm diameter bone tunnel in porcine tibiae. Cyclic loading for 1000 cycles from 0 to 250 N was applied, followed by load to failure testing. Elongation, load to failure and stiffness of the tested constructs was determined.ResultsAfter 1000 cycles at 250 N, elongation was 4.8 mm ± 1.5 in the Bc-IFS group, and 4.9 mm ± 1.5 in the Mg-IFS group. Load to failure was 649.5 N ± 174.3 in the Bc-IFS group, and 683.8 N ± 116.5 in the Mg-IFS group. Stiffness was 125.3 N/mm ± 21.9 in the Bc-IFS group, and 122.5 N/mm ± 20.3 in the Mg-IFS group. No significant differences regarding elongation, load to failure and stiffness between Bc-IFS and Mg-IFS were observed.ConclusionMagnesium IFS show comparable biomechanical primary stability in comparison to biocomposite IFS and may therefore be an alternative to contemporary biodegradable IFS.

О сроках восстановления сухожилий сгибателей пальцев кисти при травме профнастилом

The purpose — clinical assessment of the algorithm of terms of the restoration of the finger tendons’ flexor after an injury with a profiled metal sheet. Results. Based on the study results, an algorithm for restorative operations on tendons after an injury with a profiled metal sheet was proposed. When the skin-tendon flap width-to-length ratio is 1:3 or more, one-stage reconstruction of the deep flexor tendon is possible. If the flap width-to-length ratio is less than 1:3, it is necessary to conduct a primary delayed (in 7–10 days) or staged reconstruction of the deep flexor tendon with skin restoration. Conclusion. The presented graphical model of «profiled metal sheet injury» allows giving a clinical assessment of the blood supply to the skin-tendon flap and differentiating treatment of patients with varying degrees of injury severity. In turn, the restoration of normal blood circulation in the injured segment accelerates the healing process, reduces the percentage of complications, and ultimately determines the success of the surgical intervention.

Developing A Needle-Knife Surgical Device for Ultrasonic Assisted Surgery.

Introduction: A new era of orthopedic surgery is happening nowadays. Procedures like Video Surgery, Ultrasound Guided Interventions, Pain interventions invasive orthopedics procedures, hydrodissection, dry needling; thermography assisted pain procedures and acupuncture started to be widely performed [1]. Objective: The aim of the project is to assess Ultrasonic assisted surgery in pig foot from butchery using three differences needleknife devices. Method: All three needles were used for ultrasonic assisted surgery in pig feet from butchery. An ultrasonic assisted surgery was performed in 9 nine pig feet. The two well developed digits were assessed. The pig has two larger central toes. These larger central toes bear most of the weight, but the outer two are also being used in soft ground. Two toes each foot was assessed, one medial and one lateral. We numbered the pig foot from I to IX in roman figures. The first three I, II and III were used for needle A (control) for all medial and lateral toes. The samples IV, V and VI were used for needle B for all medial and lateral toes. The samples VII, VII and IX were used for needle C for all medial and lateral toes. The surgical technique consists in an ultrasonic assisted percutaneous tenotomy of the deep flexor tendon between distal and proximal phalanx near the sesamoid bone on the pig toe. Assessed for clinical release of the joint; gap in the plantar cushion pad and ecographic assessment. A final open dissection was performed [2]. Results: Model 3 presented similar features in rigidity to the baseline model 1 (3,6%). They have a similar performance. The tip of model 3 increased a tension of 15%; but does not mean fracture risk. In ultrasonic assisted surgery in pig feet from butchery the geometry; puncture capability, cutting capability, tip deformation and tip fracture. Geometry: Group A Control; group C and then group B Puncture capability: Group B; Group C and then Grupo A. Cutting ability: Group C; then A and then B. (tip of B deformation) Resistance: Group A; then group C and then group B. Deformation: needle B has a tip deformation in 50 % of the cases. Conclusion: Two different bisel tips needle shapes were modified from the original one metal guide of an intravenous catheter in order to improve the cutting ability as well as maintain the aspiration and infusion feature. One longer surface edge and another one not so long. The longest, although supposed to be the best performer is not strong enough and deformed. The second one is the most useful for needle knife instruments. More clinical study is recommended.

Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery

Immediate postoperative mobilization has been shown to avoid adhesion formation and improve range of motion after flexor tendon repair. A tubular braided construct was designed to allow for these rehabilitation protocols. In this exvivo study, 92 ovine flexor tendons were divided randomly into 2 equal groups. After creating a transection, the tendons of the first group were repaired using a tubular braided construct. This construct, consisting of a tubular braid of polypropylene and polyethylene terephthalate fibers, exerts a grasping effect on the tendon ends. The control group received a multistrand modified Kessler repair with a looped polydioxanone suture (PDS) 4-0 suture and a Silfverskiöld epitendinous repair using an Ethilon 6-0 suture. After the repair, a static and an incremental cyclic tensile test was performed until failure. During the static test, the tubular braid resulted in a significantly higher load at 3 mm gap formation (86.3 N ± 6.0 vs 50.1 N ± 11.6), a higher ultimate load at failure (98.3 N ± 12.7 vs 63 N ± 11.1), higher stress at ultimate load (11.8 MPa ± 1.2 vs 8.1 MPa ± 3.1), and higher stiffness (7.1 N/mm ± 2.9 vs 8.7 N/mm ± 2.2). For the cyclic tests, survival analyses for 1-, 2- and 3-mm gap formation and failure demonstrated significant differences in favor of the tubular braided construct. The tubular braided construct withstands the required loads for immediate rehabilitation not only in static tests, but also during cyclic tests. This is in contrast with the control group, where sufficient strength is reached during static tests, but failures occur below the required loads during cyclic testing. The tubular braided construct provides a larger safety margin for immediate intensive rehabilitation protocols.

The Transosseous Internal Four Strand Technique: A New All-Inside Technique for Zone 1 Flexor Tendon Repairs.

Multiple techniques for the repair of flexor tendon injuries in zone 1 have been proposed over time. While pull-out suture techniques and bone anchor seem to be stronger than internal suture techniques, they are associated with a higher complication rate. We therefore developed an alternative internal suture repair with similar biomechanical stability to those of pull-out sutures and bone anchors. Twenty porcine distal phalanges and deep flexor tendons were randomized to 2 groups of 10 each. The tendons were transsected at the level of the distal interphalangeal joint. In group 1, repairs were performed with a well-established intraosseous suture repair and in group 2 with our new multistrand technique. The repairs were biomechanically tested with linear distraction until failure. We recorded a significantly higher 2-mm gap force (2GF)-and thus higher stability-of the repairs in group 1 in comparison to group 2. With a 2GF of more than 50 N, our suture technique allows for a modern early active motion rehabilitation protocol. Breakage of the suture construct occurred at random places in the repair in both groups. No pull-outs were noted. This study presents a strong transosseous multistrand repair technique for flexor tendon repair in zone 1 that is simple and fast to perform and should have enough strength to withstand early active motion rehabilitation.

The Impact of Digital Nerve Injury on the Outcome of Flexor Tendon Tenolysis: A Retrospective Case-Control Study.

Tenolysis is an established treatment for flexor tendon adhesions at the hand. Concomitant finger nerve injuries with incomplete reinnervation may negatively influence outcomes. This study investigates the impact of finger nerve injuries on outcomes of flexor tendon tenolysis. A retrospective pair-matched study was conducted, including patients undergoing tenolysis for flexor tendon adhesion after primary repair of isolated superficial and deep flexor tendon injury and both finger nerves (test group [TG]). These were compared with patients (control group [CG]) with similar injuries without affection of nerves and pair-matched in age, zone of injury and follow-up. Patients' demographics, finger sensitivity, total active range of motion (TAM) before and after tenolysis and complications were retrieved. For both study groups, 10 patients each were included in this study. There were no significant differences regarding patients' demographics and follow-up. Mean follow-up was 37 (CG) and 41 (TG) months. Total active range of motion was preoperatively 81 ± 47° (CG) and 68 ± 54° (TG) and reached postoperatively 125 ± 57° (CG) and 79 ± 43° (TG). Hence, TAM improvement was significantly higher in patients without nerve damage (58 ± 16 vs 21 ± 11%; P > 0.05). Tendon ruptures occurred significantly more frequent in patients with nerve injury (n = 0.4 ± 0.52) compared with patients of the CG (n = 0; P < 0.05). This study shows that finger nerve injury with incomplete recovery after combined flexor tendon and nerve injuries of the finger negatively influences the outcomes of flexor tendon tenolysis.