The purpose of this study was to investigate the impact of repairing a zone II flexor digitorum profundus (FDP) laceration anatomically versus extra-anatomically on tendon loads and work of flexion (WOF).
Twenty digits from 5 cadaveric specimens were tested using an in vitro active finger motion simulator under 2 FDP tendon repair conditions: anatomic and extra-anatomic. Tensile loads in FDP and flexor digitorum superficialis (FDS), WOF, and total active finger range of motion (ROM) were measured using in-line load cells and electromagnetic tracking, respectively.
The anatomic repairs had no effect on tendon loads or WOF for either FDP or FDS. The extra-anatomic repairs increased FDP loads by 32% and decreased FDS loads by 9% compared with those in the intact condition. This pattern was similar for WOF following extra-anatomic repairs, which increased FDP WOF by 31% and decreased FDS WOF by 18%. Comparing the 2 repairs, FDP loads and WOF were 25% and 22% greater, respectively, with extra-anatomic repairs compared with anatomic repairs, with no significant change in FDS. Total active ROM was not affected by either repair.
In this in vitro cadaveric model, extra-anatomic repairs of FDP increased tendon loads and WOF compared with anatomic repairs.
On the basis of this study, reconstitution of the anatomic relationship of FDP and FDS at the Camper chiasm during the repair of zone II flexor tendon lacerations is recommended.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Zone 2 flexor tendon injuries: venturing into the no man’s land.Indian J Orthop. 2012; 46: 608-615
- Flexor tendon injury.in: Wolfe S.W.W. Hotchkiss R.N. Pederson W.C. Kozin S.H. Green’s Operative Hand Surgery. 6th ed. Churchill Livingstone, 2011: 189-195
- Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro.J Hand Surg Am. 2002; 27: 316-321
- Impact of flexor digitorum superficialis on gliding function of the flexor digitorum profundus according to regions in zone II.J Hand Surg Am. 2003; 28: 838-844
- “Venting” or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries.J Hand Surg Br. 1998; 23: 649-654
- Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in zone 2.J Hand Surg Eur Vol. 2007; 32: 118-129
- New developments are improving flexor tendon repair.Plast Reconstr Surg. 2018; 141: 1427-1437
- Flexor digitorum superficialis repair outside the A2 pulley after zone II laceration: gliding and bowstringing.J Hand Surg Am. 2015; 40: 653-659
- Strong digital flexor tendon repair, extension-flexion test, and early active flexion: experience in 300 tendons.Hand Clin. 2017; 33: 455-463
- Clinical anatomy of the chiasma tendlinum (camper) in the fingers.Clin Anat. 1994; 7: 65-71
- The effect of wrist position on finger tendon loads following pulley sectioning and operative reconstruction.J Hand Surg Glob Online. 2019; 1: 154-160
- Surface markers for locating the pulleys and flexor tendon anatomy in the palm and fingers with reference to minimally invasive incisions.J Hand Surg Am. 2012; 37: 913-918
- A new testing device for measuring gliding resistance and work of flexion in a digit.J Biomech. 2003; 36: 295-299
- Zone II flexor tendon repairs in the United States: trends in current management.J Hand Surg Am. 2017; 42: e99-e108
- Acute flexor tendon repairs in zone II.Hand Clin. 2005; 21: 173-179
- The gliding force and work of flexion in the early days after primary repair of lacerated flexor tendons: an experimental study.J Hand Surg Eur Vol. 2008; 33: 192-196
- Work of flexion after flexor tendon repair according to the placement of sutures.Clin Orthop Relat Res. 1995; 320: 205-210
- Flexor tendon injuries: I. Foundations of treatment.J Am Acad Orthop Surg. 1995; 3: 44-54
- Flexor tendon excursion and load during passive and active simulated motion: a cadaver study.J Hand Surg Eur Vol. 2013; 38: 964-971
- Zone II combined flexor digitorum superficialis and flexor digitorum profundus repair distal to the A2 pulley.J Hand Surg Am. 2010; 35: 1523-1527
- An anatomical study of the mechanical interactions of flexor digitorum superficialis and profundus and the flexor tendon sheath in zone 2.J Hand Surg Br. 1995; 20: 269-280
Published online: December 23, 2021
Accepted: October 28, 2021
Received: March 9, 2021
M.M.H. and E.C.M. contributed equally to this manuscript.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2023 by the American Society for Surgery of the Hand. All rights reserved.