Flexor digitorum superficialis repair outside the A2 pulley after zone II laceration: gliding and bowstringing. 2015

Michael B Geary, and Christopher English, and Zaneb Yaseen, and Spencer Stanbury, and Hani Awad, and John C Elfar
Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.

OBJECTIVE To evaluate the changes in maximum flexion angle, gliding coefficient, and bowstringing after a combined repair of both flexor tendons with the flexor digitorum superficialis (FDS) rerouted outside the A2 pulley in cadaveric hands. METHODS We performed 4 different repairs on cadaveric hands, with each repair tested on 9 unique digits. In total, 12 cadaveric hands and 36 digits were used. The thumb and little finger were removed from each hand and excluded from testing. Group 1 was sham surgery. Group 2 combined flexor digitorum profundus (FDP) and FDS laceration and repair with both slips of the FDS repaired inside the A2 pulley. Group 3 was FDP repair with one slip of the FDS repaired inside A2 and the other slip left unrepaired. Group 4 was FDP repair with both slips of the FDS rerouted and repaired outside the A2 pulley. Maximum flexion angle, gliding coefficient, and bowstringing were measured in simulated active digital motion for each group. RESULTS Rerouting and repairing the FDS outside the A2 pulley (group 4) significantly lowered gliding coefficient compared with repairs with both slips inside A2, with values similar to sham surgery. We observed no significant differences in maximum flexion angle among the 4 groups. Increased bowstringing was observed with both slips of the FDS repaired and rerouted outside the A2 pulley. CONCLUSIONS In this cadaveric model, repair of both slips of the FDS outside the A2 pulley improved the gliding coefficient relative to repair within the A2 pulley, which suggests decreased resistance to finger flexion. Repair of the FDS outside the A2 pulley led to a slight increase in bowstringing of the FDS tendon. CONCLUSIONS We describe a technique for managing combined laceration of the FDP and FDS tendons that improves gliding function and merits consideration.

UI MeSH Term Description Entries
D005383 Finger Injuries General or unspecified injuries involving the fingers. Injuries, Finger,Finger Injury,Injury, Finger
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013536 Suture Techniques Techniques for securing together the edges of a wound, with loops of thread or similar materials (SUTURES). Suture Technics,Suture Technic,Suture Technique,Technic, Suture,Technics, Suture,Technique, Suture,Techniques, Suture
D013708 Tendon Injuries Injuries to the fibrous cords of connective tissue which attach muscles to bones or other structures. Injuries, Tendon,Injury, Tendon,Tendon Injury
D013710 Tendons Fibrous bands or cords of CONNECTIVE TISSUE at the ends of SKELETAL MUSCLE FIBERS that serve to attach the MUSCLES to bones and other structures. Endotenon,Epotenon,Tendons, Para-Articular,Tendons, Paraarticular,Endotenons,Epotenons,Para-Articular Tendon,Para-Articular Tendons,Paraarticular Tendon,Paraarticular Tendons,Tendon,Tendon, Para-Articular,Tendon, Paraarticular,Tendons, Para Articular
D019637 Orthopedic Procedures Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures. Orthopedic Surgery,Surgery, Orthopedic,Orthopedic Rehabilitation Surgery,Orthopedic Surgical Procedures,Orthopedic Procedure,Orthopedic Rehabilitation Surgeries,Orthopedic Surgeries,Orthopedic Surgical Procedure,Procedure, Orthopedic,Procedure, Orthopedic Surgical,Procedures, Orthopedic,Procedures, Orthopedic Surgical,Rehabilitation Surgeries, Orthopedic,Rehabilitation Surgery, Orthopedic,Surgeries, Orthopedic,Surgeries, Orthopedic Rehabilitation,Surgery, Orthopedic Rehabilitation,Surgical Procedure, Orthopedic,Surgical Procedures, Orthopedic
D020127 Recovery of Function A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. Function Recoveries,Function Recovery
D022125 Lacerations Torn, ragged, mangled wounds. Laceration

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