Tendon Retrieval Research Articles

Current clinical opinion on surgical approaches and rehabilitation of hand flexor tendon injury-a questionnaire study.

The management of flexor tendon injury has seen many iterations over the years, but more substantial innovations in practice have been sadly lacking. The aim of this study was to investigate the current practice of flexor tendon injury management, and variation in practice from the previous reports, most troublesome complications, and whether there was a clinical interest in potential innovative tendon repair technologies. An online survey was distributed via the British Society for Surgery of the Hand (BSSH) and a total of 132 responses were collected anonymously. Results showed that although most surgeons followed the current medical recommendation based on the literature, a significant number of surgeons still employed more conventional treatments in clinic, such as general anesthesia, ineffective tendon retrieval techniques, and passive rehabilitation. Complications including adhesion formation and re-rupture remained persistent. The interest in new approaches such as use of minimally invasive instruments, biodegradable materials and additive manufactured devices was not strong, however the surgeons were potentially open to more effective and economic solutions.

Minimally Invasive Distal Biceps Tendon Reconstruction With Semitendinosus Allograft and Dual Unicortical Button Fixation

Complete rupture of the distal biceps tendon is routinely treated with direct repair; however, chronic, mid-substance, or musculotendinous tears are challenging clinical scenarios for surgeons. Although attempts at direct repair should be considered, in cases of severe retraction or tendon deficiency, a reconstruction may be warranted. Herein the authors describe a technique for distal biceps reconstruction using allograft with a Pulvertaft weave via a standard anterior incision, similar to primary repair, with a small catchment incision more proximally for tendon retrieval. Use of this technique with dual unicortical buttons allows for early range of motion, restoration of the distal footprint, and improved biomechanical construct strength, which has proven invaluable in a population of elite and highly active military servicemembers.

Techniques for Retrieval of Lacerated Flexor Tendons: A Scoping Review.

Introduction: Flexor tendon laceration is often followed by retraction of the proximal stump. The goals of this review were to describe the myriad of proximal stump retrieval surgical techniques and where available to provide the clinical evidence associated with each. Methods: A Medline and Web of Science search was performed to identify any publication whose primary purpose was to describe a tendon retrieval technique. The techniques were assigned to 8 groups. Clinical outcomes, where reported, and advantages and disadvantages of the technique as reported by the authors of the articles were analyzed. Results: Eight-hundred and forty-one publications complied with the search terms, and 33 articles were included in the current analysis. Only 2 of these articles were randomized controlled trials, and they were of low quality. Conclusion: There is no high-quality evidence to allow quantitative comparison of tendon retrieval techniques. An incremental approach can be recommended based on the qualitative review. After failed atraumatic attempts to retrieve the tendon by milking, retrieval should be done through proximal incision at the A1 pulley level, preferably without pulling the tendon out of the wound. When available, using an endoscope to retrieve the tendon appears to be a promising alternative.

A Simple, Atraumatic Technique for Tendon Retrieval and Holding During Tendon Repair.

In this report, we describe an atraumatic technique that can be used intraoperatively to hold and retrieve tendons during tendon repair procedures. To use this technique, the surgeon transfixes a 24-gauge needle 1.5-3.5 cm from the cut ends of the tendon and then uses a Kocher artery curved forceps to loop the end of the needle upon itself up to 180°. The surgeon can then use the needle to retrieve or hold the tendon during the repair. This simple, low-cost technique can be very effective and efficient when used in primary care centers, emergency departments, or other treatment areas.

Widening of Pulley by Interdigitating Cuts.

While biomechanically important, pulleys present multiple challenges to a zone 2 flexor tendon repair and rehabilitation. Retrieval of tendon through an intact pulley is cumbersome. Following repair, venting is often needed to accommodate the bulk at repair site. On occasion, step lengthening, or even complete division of pulley and reconstruction with tendon graft are necessary. Finally, accessing the tendon under the pulley during tenolysis is difficult. The primary issue in all such cases is the lack of space under the pulley. We describe a technique of expanding the pulley by interdigitating cuts. This technique greatly increases the diameter of the pulley which could be demonstrated in cadaver model and noted in clinical setting. This technique is easy to perform and maintains the integrity of the pulley without complete division. It would allow easy tendon retrieval, provide space for the repair and gliding, and improve exposure during tenolysis.

Flexor pollicis longus tendon retrieval using silicone rods; is it worth it?

The hand represents one of the most common sites for injuries in a trauma setting. Hand mobility, the arc of motion away from the body, and being involved in many of the daily activities add to this high incidence. Thumb injuries carry a substantial burden on hand function due to its mobility, distinctive motion patterns, and particular purposes it attains. This is a prospective case-control study for cases presented to the emergency department at Kasr Al-Ainy, school of medicine, Cairo University, for the period between January 2018 and July 2019, with zone II (T2) flexor pollicis longus (FPL) tendon injuries. Patients were divided into two groups: one group had FPL retrieved with the aid of silicone rods using a different wrist incision and the other group had a retrieval done through the same site of injury without the use of rods. Patients were followed up paying attention to their rehabilitation progress, return-to-work time, and complications (e.g., rupture and infections). Patients with comorbidities (e.g., diabetes mellitus), hand infections, or associated fractures were excluded from the study. One hundred patients were included in this study. Randomly, 50 patients were assigned to group A and 50 patients to group B. The age range was 16 to 75 years. Eighty percent of the patients were males, and the remaining 20% were females. Follow-up period ranged from 3 months to 1 year with a mean follow-up period of 8 months. Group A showed shorter operative time (P value < 0.001), faster return to work (P value < 0.001), and lower complication rates (P value < 0.07) than group B. The use of silicone rods represents a suitable method for FPL tendon repair with faster recovery, lower complication rates, and shorter operative times. Level of evidence: Level IV, therapeutic study.

Minimizing trauma over ‘no man’s land’ with flexor tendon retrieval

Minimizing trauma over ‘no man’s land’ with flexor tendon retrieval

Surgical Correction of the “Popeye Biceps” Deformity: Dual-Window Approach for Combined Subpectoral and Deltopectoral Access and Proximal Biceps Tenodesis

"Popeye biceps" deformity represents the appearance of a distally retracted biceps muscle resulting from either a traumatic long biceps tendon (LBT) rupture or an iatrogenic LBT tenotomy. Cosmetic and functional problems associated with the deformity may necessitate surgical correction, and surgical exposure using multiple incisions is recommended. The technique presented here describes a novel mini-open approach using a single 1-in incision that provides access to 3 peripectoral anatomical zones. Preoperative sonographic localization of the ruptured and retracted LBT is used to guide incision placement, and facilitates intraoperative tendon retrieval via a limited incision and minimal dissection. Inferolateral retraction of the mini-incision window permits infrapectoral and subpectoral LBT mobilization and dissection. Deltopectoral access via superomedial retraction of the same skin window is used to expose the suprapectoral zone and is employed for LBT retrieval and proximal tenodesis. Technical tips for safe dissection via a mini-incision, and methods for biological LBT augmentation are discussed.

Flexor Tendon Retrieval in Zone I and II

In this article we set out to describe a simple and modified Sourmelis technique for tendon retrieval in zone I and II. In this modified technique, a long loop of nylon suture is used and hence there is no need for the stage 4 of Sourmelis technique. The purpose of this paper is to illustrate this modification.

Direct Plantar Approach to Henry's Knot for Flexor Hallucis Longus Transfer

Transfer of the flexor hallucis longus (FHL) tendon is an established method to replace a dysfunctional Achilles tendon. When using a single incision, the FHL tendon has to be transferred as a single stranded graft into the calcaneus and the distal FHL stump cannot be directly attached to the flexor digitorum longus tendon (FDL). Another concern with tendon retrieval is neurovascular damage. We report our results with a direct plantar approach for tendon harvest. A direct plantar approach to the master knot of Henry with reattachment to its distal stump while protecting the medial plantar nerve was used allowing a double stranded FHL-transfer in 25 cases of a severely dysfunctional Achilles tendon in 24 consecutive patients. Patients were evaluated prospectively and at an average followup of 73 (range, 20 to 121) months. No wound healing problems and no lesion of the medial plantar nerve occurred. The subjective result was rated as excellent in 18 (72%), good in five (20%), and fair in one case (8%).The AOFAS hindfoot score averaged 95.4 (range, 61 to 100) points and the AOFAS hallux score averaged 97.6 (range, 87 to 100) points. No loss of plantarflexion force was observed in the big toe as compared to the contralateral side. The plantar approach to Henry's knot allowed the use of a double stranded FHL transplant. The distal stump was attached to the FDL tendon to preserve flexion at the great toe without damaging to the medial plantar nerve.

Flexor tendon retrieval—another way

A simple method of flexor tendon retrieval after division in Zones I and II injuries using a silastic urinary catheter is described.

A Simple, Semirigid, and Surgeon-Friendly Tendon Retriever and Flexor Sheath Dilator

The repair of flexor tendons remains a challenge to the hand surgeon, and zone II repair requires a trained and experienced surgeon for good results. If the tendon has retracted proximally, however, its retrieval through the inflamed and swollen flexor sheath in acute cases and through a shrunken flexor sheath in case of a delayed repair/reconstruction can test any surgeon's skill and patience. Although there are many methods described in the literature for tendon retrieval, most are either not successful or are traumatic to the tendon or its fibrous sheath. We herein describe a semirigid tendon retriever that can be made intraoperatively and is useful in both acute and delayed repairs/reconstructions. The extremely low cost is a special feature. It has been proven to be a simple and effective method of tendon retrieval and also a flexor sheath dilator in delayed repairs/reconstructions.

Tendon retrieval in zone I & II injuries—a visit of new technique

When an injury occurs with the digit in flexion, theproximal ends of the divided flexor Tendons of thethumb or the fingers usually retract as far proximalasthecarpaltunnel oreven theverydistal forearm.Retrievalcanbedifficultastheflexortendonsheathis not uniform. It is narrower at the joints becausethe palmar plates protrude into the flexor sheathand the ends of the bones are bulbous.

Endoscopic retrieval of severed flexor tendons: a study of technique using cadaveric hands.

Retrieval of retracted zone 1, 2, and 3 flexor tendons without a proximal incision can occasionally lead to excessive tendon trauma or injury to neurovascular structures. To determine if endoscopic flexor tendon retrieval is a reliable, reproducible technique, 34 zone 2 flexor tendon lacerations were created in four cadaveric hands (2 male; 2 female). The tendons were retracted proximally an average of 4.3 +/- 1.9 cm (range, 2-10 cm) through a separate transverse wrist incision. A 2.5-mm flexible endoscope was introduced into the distal tendon sheath, and all transected tendons (N = 34) were clearly visualized. Thirty-two tendons (94%) were retrieved endoscopically by using either a loop snare or grasping forceps. Two tendons (6%) in a small female hand could not be retrieved endoscopically. This minimally invasive technique may be an alternative to the blind grasping maneuvers, proximal incision extensions, and counter-incisions in the palm.

A further tendon retrieval trick

Atraumatic delivery of the retracted flexor tendon ends following laceration is crucial for accurate tenorrhaphy. Sourmelis and McGrouther (1987) developed a useful method of delivering the proximal flexor tendon and a modification is presented here which further aids atraumatic tenorrhaphy.

A modification of the catheter method for retrieval of divided flexor tendons

A simple modification of the catheter technique for retrieving flexor tendons is presented. The technique is based on the Seldinger principle. A flexible metal guide-wire is used to route a polythene catheter through the flexor tendon sheath, enabling tendon retrieval.

Endoscopic retrieval of severed flexor tendons

Retrieval of the proximal end of severed flexor tendons can be accomplished using several techniques. L.2 Flexion of the wrist and metacarp phalangealjoints along with proximal-to-distal massage of the forearm and palm can bring the tendon into view. A grasping instrument, such as a hemostat, can deliver the tendon. When these maneuvers fail, proximal incisions to locate the tendon becomes necessary. However, these incisions extend the surgical wound and increase the scar burden. We describe a technique for flexor tendon retrieval that eliminates the need for proximal incisions.

Flexor Tendon Injuries: II. Operative Technique.

The repair of flexor tendons (zones I and II) is a technique-intensive surgical undertaking. It requires a strong understanding of the anatomy of the tendon sheath and the normal relationship between the pulleys and the flexor digitorum superficialis and flexor digitorum profundus tendons in the digit. Meticulous exposure, careful tendon retrieval, and atraumatic repair are extremely important, and the repair should be of sufficient strength to resist gapping and permit the early postrepair application of motion forces. Whenever possible, the tendon sheath should be preserved or repaired, and a smooth gliding surface should be reestablished. The author describes an effective method of tendon retrieval and a simplified technique for a four-strand tendon repair with a supplementary peripheral running-lock suture. The repair is considered to maintain sufficient strength throughout healing to allow a postrepair rehabilitation protocol that will impart passive and modest active stress forces to the repaired tendons. Complications include tendon rupture, digital joint flexion contractures, and adhesions that restrict tendon gliding and ultimately necessitate tenolysis.