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A Novel Tenodesis Procedure for the Treatment of Unrepairable Zone I Flexor Tendon Injuries
Douglas Sammer, MD; Tamir Pritsch, MD
University of Texas Southwestern Medical Center, Dallas, TX

Introduction: Isolated zone I flexor digitorum profundus (FDP) injuries often present late, making primary repair impossible. Often, loss of overall hand function is minor, and surgical intervention may not be required. However, some patients experience distal interphalangeal (DIP) joint hyperextension and instability during pinch. In this subset of patients, treatment options include FDP reconstruction with graft, DIP arthrodesis, or a soft-tissue procedure to stabilize the DIP joint. The purpose of this study is to present a novel dynamic tenodesis can be used to restore DIP joint flexion in patients with unrepairable isolated FDP injuries.
Methods: Four fresh frozen cadaveric upper extremity specimens were obtained. In 16 fingers, the FDP tendon was transected 1 cm proximal to its insertion to simulate an isolated zone I laceration. The simulated injury was reconstructed using a novel tenodesis procedure: a palmaris longus tendon graft was used to create a mechanical linkage between the PIP and DIP joints, which restored coordinated PIP and DIP joint flexion (Figure 1). Joint motion and the force required to flex and extend the fingers were tested before and after the tenodesis procedure (Table I).
Results: In the zone I laceration model, DIP joint flexion with load applied to the FDS tendon averaged 2° prior to the tenodesis procedure, and increased to a mean of 57° after the tenodesis procedure. The sum of MCP, PIP and DIP joint flexion averaged 186° prior to the tenodesis procedure, and increased to a mean of 233° after the tenodesis procedure. The force required to achieve fingertip to palm contact by loading the FDS tendon, and the force required to fully extend the PIP joint by loading the radial lateral band were not altered.
Summary: The tenodesis procedure successfully restored coordinated interphalangeal joint flexion after a simulated zone I FDP laceration, with improvements in both DIP joint flexion and composite finger flexion. Factors such inflammation, edema, and scar formation could not be evaluated. Although the in-vivo results are unknown, the potential utility of this procedure for treating patients with unrepairable isolated zone I FDP injuries was demonstrated.


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