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The Journal of Bone and Joint Surgery (American) 84:1006-1012 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Treatment of Partial Lacerations in Flexor Tendons by Trimming

A Biomechanical in Vitro Study

Lionel Erhard, MD, Mark E. Zobitz, MS, Chunfeng Zhao, MD, Peter C. Amadio, MD and Kai-Nan An, PhD

Investigation performed at the Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Lionel Erhard, MD
Mark E. Zobitz, MS
Chunfeng Zhao, MD
Peter C. Amadio, MD
Kai-Nan An, PhD
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 National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases) Grant AR 44391 and 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: Treatment of a partial laceration in zone 2 of a flexor tendon is controversial. The intact part of the tendon can usually sustain forces of normal unresisted motion, and repaired partially lacerated tendons can actually be weaker than unrepaired ones. However, complications such as triggering or entrapment have been reported in association with unrepaired tendons. The purpose of this study was to measure the biomechanical behavior following trimming of the tendon as an alternative to repair.

Methods: Thirty-six flexor digitorum profundus tendons were harvested from sixteen unpaired fresh-frozen cadaveric human hands and were randomly assigned to be subjected to either 50% or 75% partial laceration, which was either lateral or volar, and were then assigned to no repair, repair with a running suture, or trimming. Mean and maximum gliding resistances were measured as the flexor digitorum profundus glided through the bone-A2 pulley complex and the flexor digitorum superficialis. Values were normalized to those measured in the intact tendon. The tendons were then distracted to failure, and maximum load and stiffness were recorded.

Results: There was triggering or entrapment of eight unrepaired tendons; two cases were severe, and six were minor. When no severe trigger was obvious, the unrepaired tendons had the lowest tendency for gliding resistance, followed by the tendons treated with trimming and then by those treated with the running suture. Overall, the tendons with a volar laceration had higher mean and maximum gliding resistance than those with a lateral laceration (p < 0.05), those with a 75% partial laceration had higher mean gliding resistance than those with a 50% laceration (p < 0.05), and the tendons that were repaired with running suture had higher mean gliding resistance than those treated with trimming (p < 0.05). Tendon strength was not significantly different among the three types of treatment.

Conclusions: From the perspective of gliding resistance after partial tendon laceration, no repair appears necessary unless triggering is a problem. If triggering occurs, then trimming of a partially lacerated tendon may be a reliable alternative to repair, at least in terms of gliding resistance and strength.


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