Flexor tendon graft for late management of isolated rupture of the profundus tendon.

BACKGROUND: Late management options for the neglected flexor tendon injury include arthrodesis, tenodesis, tendon advancement, or tendon grafting. Although the clinical outcomes of single-stage and second-stage flexor tendon grafting are satisfactory, many controversies exist. The present study retrospectively reviewed the clinical outcomes of flexor tendon grafting for 15 patients with isolated profundus rupture.
METHODS: Fifteen cases of isolated rupture of the flexor profundus tendon were treated by free tendon graft. The age of the patients ranged from 13 to 21 years (mean, 17.3 years). The time from injury to operation ranged from 4 to 14 weeks (mean, 8.3 weeks). All tendon grafts were passed through the intact superficialis tendon to repair the injured profundus tendon. These patient were followed up from 14 to 62 months after treatment mean, 31.3 months).
RESULTS: All but one patient had less than 3.2 cm of flexion from fingertip to mid-palmar crease. Fourteen patients achieved active distal interphalangeal (DIP) joint flexion of more than 20 degrees. Four patients developed extension loss of the proximal interphalangeal (PIP) joint of more than 30 degrees after surgery. The mean active flexion after surgery was 33 degrees (range, 15-55 degrees) for DIP joints and 91.3 degrees (range, 80-100 degrees) for PIP joints. Three patients had combined extension loss of PIP and DIP joints of more than 40 degrees for the index and middle fingers. Twelve patients (80%) had satisfactory results, whereas treatment of the other 3 patients was considered unsuccessful.
CONCLUSION: Flexor tendon graft can be used to reconstruct the isolated rupture of the profundus tendon and achieve satisfactory results for properly selected patients.