Single-Stage Flexor Tendon Reconstruction Using Tendon Grafting Versus Turnover Tendon Split-Lengthening Technique.

PURPOSE: This study aimed to evaluate the long-term functional outcomes and complication rates of single-stage flexor tendon reconstruction using either traditional tendon grafting or the turnover split-lengthening technique in patients with flexor tendon injuries that were unsuitable for primary repair.

METHODS

We retrospectively reviewed 14 patients who underwent single-stage flexor tendon reconstruction between 2014 and 2022. Seven patients received palmaris longus tendon grafts, and seven underwent the turnover split-lengthening procedure. Inclusion criteria comprised adequate soft tissue coverage and absence of excessive scarring; two-stage reconstructions were excluded. Functional outcomes were assessed by total active range of motion (AROM) using the modified Strickland formula, grip strength, and patient-reported function via the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Complications, including tendon adhesions, joint contractures, and bowstringing, were recorded.

RESULTS

At a mean follow-up of 5.7 ± 3 years, the mean total AROM was 67.6 ± 14.5%, with outcomes classified as excellent in three patients, good in four, fair in six, and poor in one. Mean grip strength was 90.7 ± 9.2% of the contralateral hand, and the mean QuickDASH score was 2.9 ± 5. There were no statistically significant differences between tendon grafting and turnover split-lengthening in AROM, grip strength, or QuickDASH scores (P = .69, .59 and .26, respectively). However, a greater proportion of patients treated with tendon grafting achieved excellent or good outcomes according to the Strickland criteria (5/7 vs 2/7); however, this difference did not reach statistical significance. Complications were observed in 50% of patients, predominantly in those with suboptimal functional results, but did not differ by reconstruction technique.

CONCLUSIONS

Single-stage flexor tendon reconstruction using either tendon grafting or turnover split-lengthening, provides comparable functional outcomes, grip strength, and patient-reported satisfaction. The turnover technique is a viable alternative, particularly when the palmaris longus is absent or donor-site morbidity is a concern. Both techniques are associated with a high incidence of complications, emphasizing the challenges of secondary tendon reconstruction.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.