Current Methods and Biomechanics of Extensor Tendon Repairs

Dy, Christopher J.; Rosenblatt, Lauren; Lee, Steve K.

doi:10.1016/j.hcl.2013.02.008

Cited by 19 publications

(16 citation statements)

References 24 publications

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“…Tendon shortening and resultant loss of MCP and PIP flexion were also accompanied by an increase in the force required to obtain maximum flexion, which may contribute to scar elongation and resultant extensor lag. Also, adhesion formation and suturing technique weakness, with resultant tendency to gap formation, can lead to extension lag ( 8 , 9 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Roll Stitch Technique and Core Suture Technique for Extensor Tendon Repair at the Metacarpophalangeal Joint level

2016

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Background:Proper suturing technique is needed to ensure good outcome in extensor tendon surgery. Different techniques have been reported for the repair of extensor tendon injuries at the level of the metacarpophalangeal joint (MCPJ). These reports were in vitro studies on cadaver models. Repair techniques must be clinically tested, to determine results.Objectives:The purpose of this in vivo study was to compare results of extensor tendon repair, using roll stitch and core suture techniques.Patients and Methods:Forty two fingers, in 38 patients (aged 15- 45 years), with simple complete extensor tendon injuries in the MCPJ area, were identified and operated by a single surgeon. The patients were divided into two groups, according to the technique used for tendon repair. The first group consisted of 21 digits, in 19 patients, who were repaired with roll stitch technique, while the second group consisted of 21 digits, in 19 patients, who were repaired with core suture technique. The same splint and rehabilitation regimen (early passive range of motion) were given to all patients. The splints were removed at 6 weeks after surgery and range of motion of the operated fingers was measured and compared to uninjured hands, after 12 weeks.Results:Five patients were lost to follow up or excluded from the study. There was no rupture of the repaired tendons in the groups. There was no statistically significant difference in mean MCPJ flexion, proximal interphalangeal joint (PIPJ) flexion, distal interphalangeal joint (DIPJ) flexion and total range of motion of the fingers, between the two groups. However, extension lag was significantly more common in the second group (11 of 19 digits) compared the first group (four of 17 digits).Conclusions:Roll stitch technique had superior outcome compared to the modified Kessler technique, when performed in the MCPJ area. Level of evidence: Therapeutic (Level III)

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Section: Discussionmentioning

confidence: 99%

Comparison of Roll Stitch Technique and Core Suture Technique for Extensor Tendon Repair at the Metacarpophalangeal Joint level

2016

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“…1 Following those criteria is a common opinion that ETIs in zones 1 to 4 have worse results than those in zones 5 to 8. 8,14,60 Long-term results of extensor tendon repair have been described by Newport et al 60 who observed a significant positive trend in patients with isolated tendon injuries compared with those having associated bone, joint, and flexor tendon lesions. Moreover, the same authors reported 63 to 83% of favorable results in the proximal zones (5-8) compared with less than 50% of good results in the distal zones (1)(2)(3)(4).…”

Section: Overviewmentioning

confidence: 96%

“…31 Ultrasonography is noninvasive, low-cost, and sensitive method for the confirmation of complete lesions and the detection of particular tendon injuries such as partial tendon tears or distal zones ETIs, and at present it is considered a reliable and useful diagnostic tool in such field of study. 8,32 MR has high diagnostic value to assess tendon injuries of the hand. 33,34 In a cadaveric study by Clavero et al who examined the MR findings of extensor tendon apparatus of the hand, 33 it was reported that this technique allowed accurate identification and depiction of most tendinous and retinacular structures, describing similar findings to those obtained with macroscopic dissection.…”

Section: Imagingmentioning

confidence: 99%

“…This technique is performed rapidly and allows an early mobilization, thanks to the favorable biomechanical properties suggesting that this suture may be an ideal configuration for extensor tendons repair. 4,8 A specific problem is represented by complex ETI, where significant bone and soft tissue lesions following major hand trauma are usually associated. These injuries require more complex techniques for tendon reconstruction, soft tissue coverage, skeletal repair, and eventual treatment of concomitant vascular and nerve injuries.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…[3][4][5][6][7] Because of this operative approach, surgical outcomes have significantly improved over the time in most cases. [6][7][8] In this review we describe the current literature evidence on the physiopathology, diagnostic imaging, and treatment options of acute and chronic ETI, including conservative treatment and surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review

Colzani¹,

Tos²,

Battiston

et al. 2016

J Hand Microsurg

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The extensor apparatus is a complex muscle-tendon system that requires integrity or optimal reconstruction to preserve hand function. Anatomical knowledge and the understanding of physiopathology of extensor tendons are essential for an accurate diagnosis of extensor tendon injuries (ETIs) of the hand and wrist, because these lesions are complex and commonly observed in clinical practice. A careful clinical history and assessment still remain the first step for the diagnosis, followed by US and MR to confirm the suspect of ETI or to investigate some doubtful conditions and rule out associate lesions. During last decades the evolution of surgical techniques and rehabilitative treatment protocol led to gradual improvement in clinical results of ETI treatment and surgical repair. Injury classification into anatomical zones and the evaluation of the characteristics of the lesions are considered key points to select the appropriate treatment for ETI. Both conservative and surgical management can be indicated in ETI, depending on the anatomical zone and on the characteristics of the injuries. As a general rule, an attempt of conservative treatment should be performed when the lesion is expected to have favorable result with nonoperative procedure. Many surgical techniques have been proposed over the time and with favorable results if the tendon injury is not underestimated and adequately treated. Despite recent research findings, a lack of evidence-based knowledge is still observed in surgical treatment and postoperative management of ETI. Further clinical and biomechanical investigations would be advisable to clarify this complex issue.

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