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. 2020 Apr 18;2(3):159-165.
doi: 10.1016/j.jhsg.2020.03.005. eCollection 2020 May.

Flexor Tendon Grafting Using Extrasynovial Tendons Followed by Early Active Mobilization

Koji Moriya  1 , Takae Yoshizu  1 , Yutaka Maki  1
Affiliations

Flexor Tendon Grafting Using Extrasynovial Tendons Followed by Early Active Mobilization

Koji Moriya et al. J Hand Surg Glob Online. .

Abstract

Purpose: This study evaluated the outcomes of early active mobilization after flexor tendon grafts using extrasynovial tendons with a novel distal fixation technique.

Methods: This study was a retrospective case series. The flexor digitorum profundus (FDP) tendons of 7 digits in 7 patients were reconstructed with extrasynovial tendons, which included the palmaris longs, plantaris, and extensor digitorum longus, in a single- or 2-stage procedure between 2008 and 2017. Of the 7 patients, 6 were male and the average patient age was 48 years. The injuries involved 2 middle, 2 ring, and 3 little fingers. The tendons were sutured into the appropriate FDP tendon proximally using end-weave anastomosis; the distal end of the graft was fixed to the distal stump of the FDP using an interlacing suture or a small bone anchor combined with the pull-through technique. The digits were mobilized with a combination of active extension and passive and active flexion in a protective orthosis during the first 6 weeks after surgery. Average follow-up was 18 months. We measured active and passive digit motion both before tendon grafting and at the final evaluation. Outcomes were graded by the LaSalle formula to assess staged flexor tendon reconstruction.

Results: Average passive range of motion (ROM) of the proximal and distal interphalangeal joints before flexor tendon grafting was 146° (SD, 22°). Mean active ROM of these joints at the final evaluation was 123° (SD, 34°). Using the LaSalle formula, mean recovery of active motion was 83%. We encountered no grafted tendon rupture and no finger required tenolysis.

Conclusions: Our proximal and distal fixation techniques allowed the autologous extrasynovial tendon grafts to withstand the stress encountered during early active mobilization with good postoperative ROM and minimal complications.

Type of study/level of evidence: Therapeutic I.

Keywords: Early active mobilization; Extrasynovial tendon; Flexor tendon injury; Tendon grafting.

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Figures

Figure 1
Figure 1
Fixation method for the distal end of the tendon graft. A The distal portion of the graft was woven through the distal stump of the FDP tendon. B When the distal stump of the FDP tendon was unavailable, the distal end of the graft was fixed using a small bone anchor combined with the pull-through technique. The graft was passed through the pulp space and the skin over the tip of the finger, and then fixed with a small bone suture anchor. The skin was closed after the protruding end was removed and allowed to fall back into the pulp.
Figure 2
Figure 2
Bowstringing of the middle finger was evident at the final visit.
Figure 3
Figure 3
Clinical photographs of a 36-year-old man who underwent 1-stage reconstruction of the middle finger of the right hand using a palmaris longus tendon graft. A Preoperative active flexion and extension. B The distal end of the graft was anchored to the distal stump of the FDP using an interlacing suture. The grafted tendon was sutured into the proximal stump of the FDP tendon via an end-weave anastomosis. C Postoperative active flexion and extension at 14 months after surgery.
See this image and copyright information in PMC

References

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