Biomechanical Study of the Digital Flexor Tendon Sliding Lengthening Technique

Abstract

Purpose: To compare the mechanical properties of sliding lengthening (SL) and Z-lengthening (ZL) for flexor tendon elongation used for conditions such as Volkmann contracture, cerebral palsy, and poststroke spasticity.

Methods: We harvested 56 flexor tendons, including flexor pollicis longus tendons, flexor digitorum superficialis tendons (zones II to IV), and flexor digitorum profundus tendons (zones II to V) from 24 upper limbs of 12 fresh cadavers. Each tendon was harvested together with its homonymous tendon from the opposite side of the cadaver and paired. We used 28 pairs of tendons and divided them randomly into 4 groups depending on the lengthening distance (20 or 30 mm) and type of stitching (single or double mattress sutures). Then we divided each pair into either the SL or ZL group. Each group was composed of 7 specimens. The same surgeon lengthened all tendons and stitched them with 2-0 polyester sutures. We tested biomechanical tensile strength immediately after completing lengthening and suturing in each group.

Results: Ultimate tensile strengths were: 23 N for the SL 20-mm lengthening and single mattress suture and 7 N for the ZL; 25 N for the SL 20-mm lengthening and double mattress suture and 10 N for the ZL; 15 N for the SL 30-mm lengthening and single mattress suture and 8 N for the ZL; and 18 N for the SL 30-mm lengthening and double mattress suture and 10 N for the ZL.

Conclusions: The SL technique may be a good alternative to the ZL technique because it provides higher ultimate tensile strength.

Clinical relevance: Because of its higher ultimate tensile strength, the SL technique may allow for earlier rehabilitation and reduced risk of postoperative complications.

Keywords: Flexor tendon lengthening; Z-lengthening; sliding lengthening.