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Flexor Digitorum Profundus Tendon to Bone Repair Using a Multi-Strand Suture Technique

Avulsion of the flexor digitorum profundus (FDP) tendon from its insertion is repaired by direct suture reattachment of the tendon stump to its insertion site on the distal phalanx. Historically, two-strand repairs of the FDP tendon to the distal phalanx were performed using pull-out suture or wire. Ex-vivo mechanical testing has shown that all two-strand tendon-bone repairs were similar in initial time zero biomechanical properties when compared with two-strand tendon-tendon repairs. These repairs were therefore unlikely to successfully withstand forces generated at the repair site during early postoperative mobilization. Recent research using an ex-vivo human cadaver hand model has shown that repair of the FDP tendon to the distal phalanx using a fouror eight-strand suture technique is stronger than the two-strand repair and thus may be more resistant to early postoperative gap formation. Additionally, four and eight-strand suture constructs tied over a dorsal button show improved biomechanical characteristics compared with fouror eightstrand repairs anchored to bone with an intraosseous suture anchor. The purpose of this report is to describe a technique for the repair of the FDP tendon avulsion using an eight-strand suture technique anchored to the distal phalanx using a dorsal tie-over button.