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The Journal of Bone and Joint Surgery (American) 84:2039-2045 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Pulley Plasty Versus Resection of One Slip of the Flexor Digitorum Superficialis After Repair of Both Flexor Tendons in Zone II

A Biomechanical Study

P. J. Paillard, MD, P. C. Amadio, MD, C. Zhao, MD, M. E. Zobitz, MS and K. N. An, PhD

Investigation performed at the Department of Orthopedics, Orthopedic Biomechanics Laboratory, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

P.J. Paillard, MD
P.C. Amadio, MD
C. Zhao, MD
M.E. Zobitz, MS
K.N. An, PhD
Department of Orthopedics, Orthopedic Biomechanics Laboratory, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio: pamadio{at}mayo.edu

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases) grant AR44391 and a grant from the Mayo Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The outcome of repair of zone-II lacerations of the flexor digitorum superficialis and flexor digitorum profundus tendons remains suboptimal. We investigated the effects of two strategies to improve postoperative gliding in a human cadaveric hand.

Methods: The second, third, and fourth digits were harvested from ten fresh-frozen human cadaveric hands. Complete lacerations and repairs were made to the profundus and superficialis tendons at a location where both repair sites would pass beneath the A2 pulley with the proximal interphalangeal joint in 45&degree; of flexion. The gliding resistance of the flexor digitorum profundus tendon was measured following pulley plasty and following excision of one slip of the flexor digitorum superficialis. The breaking strength of the remaining slip of the flexor digitorum superficialis tendon was then measured.

Results: Pulley plasty and resection of one slip of the flexor digitorum superficialis tendon both significantly decreased gliding resistance compared with repair of both slips (p < 0.001). There was no difference in the mean gliding resistance between the pulley plasty and one-slip resection groups. The flexor digitorum superficialis slip was stronger after repair with a Becker suture (28.8 ± 9.0 N) than after repair with a modified Kessler (16.4 ± 4.5 N) or a zigzag suture (15.0 ± 5.7 N).

Conclusion: Both pulley plasty and resection of one slip of the flexor digitorum superficialis reduce gliding resistance after tendon repair in zone II of the hand.


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