Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;17(2):285-292.
doi: 10.1177/1558944720930294. Epub 2020 Jul 1.

Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Luca L Bruin  1 , Jonathan Lans  1 , Kyle R Eberlin  1 , Neal C Chen  1
Affiliations

Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Luca L Bruin et al. Hand (N Y). 2022 Mar.

Abstract

Background: The aim of flexor pollicis longus (FPL) repair is to create a construct that is strong enough to withstand forces encountered during rehabilitation and to achieve an optimal active range of motion. The aim of this study was to: (1) assess factors influencing active thumb interphalangeal (IP) joint flexion; and (2) assess the factors associated with reoperation. Methods: Retrospectively, 104 patients with primary repair of a Zone II FPL laceration from 2000 to 2016 were identified. A medical chart review was performed to collect patient-, injury-, and surgery characteristics as well as the degree of postoperative active IP-flexion and occurrence of reoperation. Bivariate analyses were performed to identify factors influencing active IP-flexion and factors associated with reoperation. Results: The reoperation rate was 17% (n = 18) at a median of 3.4 months (range: 2.3-4.4). Indications for reoperation mainly included adhesion formation (n = 10, 56%) and re-rupture (n = 5, 28%). The median range of active IP-flexion was 30° (interquartile range [IQR]: 20-45) at a median of 12.4 weeks (IQR: 8.1-16.7). Solitary injury to the thumb (β = 17.9, P = .022) and the use of epitendinous suture (β = 10.0, P = .031) were associated with increased active IP-joint flexion. No factors were statistically associated with reoperation. Conclusions: About 1 in 5 patients undergo reoperation following primary repair of a Zone II FPL laceration, mostly within 6 months of initial surgery. The use of epitendinous suture is associated with greater active IP-flexion. Patients with multiple digits injured accompanying a Zone II FPL laceration have inferior IP-joint motion.

Keywords: FPL; anatomy; basic science; digits; flexor pollicis longus; flexor tendon; interphalangeal flexion; reoperation; tendon.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: L.L.B. and J.L. declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. N.C.C. is a consultant for Flexion Medical, Miami Device Solutions and a lecturer for DePuy Synthes. KRE is a consultant for AxoGen and Integra.

Figures

Figure 1.
Figure 1.
Survival time (months) to reoperation.
See this image and copyright information in PMC

References

    1. Tang JB. Flexor tendon injuries. Clin Plast Surg. Jul. 2019;46(3):295-306. - PubMed
    1. Pan ZJ, Qin J, Zhou X, et al.. Robust thumb flexor tendon repairs with a six-strand M-Tang method, pulley venting, and early active motion. J Hand Surg Eur Vol. 2017;42(9):909-914. - PubMed
    1. Rappaport PO, Thoreson AR, Yang TH, et al.. Effect of wrist and interphalangeal thumb movement on zone T2 flexor pollicis longus tendon tension in a human cadaver model. J Hand Ther. 2015;28(4):347-354; quiz 355. - PubMed
    1. Edsfeldt S, Eklund M, Wiig M. Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands. J Hand Ther. 2019;32(3):328-333. - PubMed
    1. Dy CJ, Hernandez-Soria A, Ma Y, et al.. Complications after flexor tendon repair: a systematic review and meta-analysis. J Hand Surg Am. 2012;37(3):543-551. - PubMed

LinkOut - more resources