[Comparison between different anchors for zone I flexor tendon repair]. / Comparaison des différentes ancres dans les réinsertions transosseuses de tendons fléchisseurs profonds en zone I.

INTRODUCTION: Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use. MATERIAL AND METHOD: This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score. RESULTS: The average age was 38.6 years (± 16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH. CONCLUSION: Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) for Flexor Tendon Repairs as Change in Practice During the COVID-19 Pandemic: A Retrospective Cohort Study With Outcomes.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic forced many changes. In our unit, there was a significant shift from traditional anesthesia (TA) which included general or regional anesthesia, to Wide-Awake Local Anesthesia No Tourniquet (WALANT) for the treatment of flexor tendon injuries. Zones I and II injuries have always been a challenge. The primary aim of this study is to compare the 12-week range of motion (ROM) flexor tendon repair outcomes between the TA group and wide-awake (WA) group patients. The secondary aim is to compare the complications and the follow-up rate between the two groups. METHODS: All patients who underwent a primary finger flexor tendon repair in zone I or II without tendon graft for closed avulsions or open lacerations between April 2020 and March 2021 were included in the study. Electronic medical records were reviewed to record demographics, follow-up, ROM outcomes and complications. RESULTS: Forty-four patients with 49 injured fingers were in the WA group, and 24 patients with 37 injured fingers were in the TA group. A complete follow-up with 12-week ROM outcomes was available for 15 patients with 16 injured fingers in the WA group and nine patients with 13 injured fingers in the TA group. Excellent to good outcomes in the WA group were reported in 56% of the cases versus 31% in the TA group, although the difference was not statistically significant. There were similar complications in both groups, with an overall rupture rate of 11.6%, a tenolysis rate of 3.5% and a reoperation rate of 9.3%. Complete 12-week follow-up was completed by 41% of patients overall after taking tendon ruptures into account. CONCLUSIONS: This is one of the first studies comparing zones I and II flexor tendon ROM outcomes between WA anesthesia and TA. Overall, there was a trend toward superior ROM outcomes in the WA group, with similar complication rates in both groups. The difference between ROM outcomes was not statistically significant and the small sample size undermined the strength of the study. To provide stronger evidence, better-designed prospective studies are suggested that would compare WA techniques with TA techniques.

Cyclic Testing of a Modified Pull-Out Suture Repair Technique for Flexor Digitorum Profundus Avulsion in a Turkey Foot Model.

Background: Numerous repair techniques have been described for closed flexor digitorum profundus (FDP) avulsion. One option is a pull-out suture tied over the nail plate (Bunnell repair). We modified the Bunnell repair by incorporating a portion of the distal interphalangeal (DIP) joint volar plate into the repair to improve strength and reduce gapping. The aim of this study is to compare gap formation and load to failure between the Bunnell repair and our modification in a turkey foot model. Methods: Twenty-four fresh-frozen cadaveric turkey feet were divided into two repair groups namely the conventional Bunnell pull-out suture technique and the modified Bunnell pull-out suture technique, incorporating the middle-third of the DIP joint volar plate into the repair. Both repairs were carried out with 3-0 prolene suture and underwent ex-vivo cyclic loading at 2-12 n in a sinusoidal wave for 100 cycles to simulate a passive range of motion (ROM) protocol. Subsequently, specimens were loaded to failure at 12 mm/minute. Gap formation and load to failure were measured. Results: No repair ruptures occurred during cyclical testing. Mean gap formation was 9.2 mm (±1.49) in the Bunnell repair, and 3.5 mm (±1.19) in the modified Bunnell repair (p < 0.0001). The mean load to failure for the Bunnell repair was 35.4 n compared to 45 n for the modified repair (p = 0.0017). Conclusions: Gap formation was reduced and load to failure increased by augmenting the Bunnell pull-out suture repair with the central portion of the DIP joint volar plate.