Toe extensor digitorum longus as an alternative graft for zone 2 flexor tendon reconstruction

Area of Science:

• Orthopedic surgery
• Hand surgery
• Reconstructive surgery

Background:

• Zone 2 flexor tendon reconstruction is complex.
• Palmaris longus tendon is a common graft choice.
• Extensor digitorum longus tendon is an alternative when palmaris longus is unavailable.

Purpose of the Study:

• To compare functional outcomes of palmaris longus versus extensor digitorum longus tendon grafts for zone 2 flexor tendon reconstruction.
• To evaluate the impact of single-stage versus two-stage procedures on outcomes.

Main Methods:

• Retrospective cohort study of 27 patients undergoing flexor tendon reconstruction.
• Grafts used: palmaris longus (17 patients) or extensor digitorum longus (10 patients).
• Functional outcomes assessed using Strickland score at ≥12 months follow-up.

Main Results:

• Single-stage reconstructions yielded better functional outcomes than two-stage procedures.
• No significant difference in overall functional outcomes between graft types.
• In single-stage repairs, extensor digitorum longus grafts showed higher Strickland scores than palmaris longus grafts.

Conclusions:

• Extensor digitorum longus tendon is a viable alternative for zone 2 flexor tendon reconstruction.
• Overall functional outcomes are comparable between graft types.
• Higher scores with extensor digitorum longus in single-stage repairs require prospective validation.