Surgical Techniques   |    
A Device for Zone-II Flexor Tendon Repair
Brian W. Su, MD1; Michael Solomons, MD3; Andrew Barrow, MD4; Matshediso E. Senoge, MD5; Marco Gilberti, MD6; Lawrence Lubbers, MD7; Edward Diao, MD8; H. Matthew Quitkin, MD9; Michael W. Grafe, MD1; Melvin P. Rosenwasser, MD2
1 Department of Orthopaedic Surgery, The Trauma Training Center, New York Presbyterian Hospital, 622 West 168th Street, PH 11, Room 11-64, New York, NY 10032.
3 University of Cape Town, Room 128, Vincent Pallotti Hospital, Alexandra Road, Pinelands, Cape Town 7405, South Africa
4 P.O. Box 902, Wendywood 2144, South Africa
5 Nelson R. Mandela School of Medicine, 5 Pfanner Road, Marion Hill Park, Pinetown 3610, South Africa
6 Via Usignolo 1, 20147 Milan, Italy
7 Hand and Microsurgery Associates, 3400 Olentangy River Road, Suite 200, Columbus, OH 43202
8 Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, Room MU 320-W, Box 0728, San Francisco, CA 94143-0728
9 415 Church Street, Suite 101, Vienna, VA 22180
2 Department of Orthopaedic Surgery, The Trauma Training Center, New York Presbyterian Hospital, 622 West 168th Street, PH 11, Room 11-64, New York, NY 10032. E-mail address for M.P. Rosenwasser: ttc@columbia.edu
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 923-935, May 2005
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Ortheon Medical, Winter Park, Florida and Tendon Technology, LLC. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Ortheon Medical and Tendon Technology, LLC). Also, a commercial entity (University of California, San Francisco) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart@haderermuller.com).
Investigation performed at Columbia University Medical Center, New York, NY, Groote Schuur Hospital, Cape Town, Johannesburg General Hospital, Johannesburg, and King Edward VIII Hospital, Durban, South Africa

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(1 suppl 1):37-49. doi: 10.2106/JBJS.E.00978
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BACKGROUND: The stainless-steel Teno Fix tendon-repair device has improved biomechanical characteristics compared with those of suture repair, and it was well tolerated in a canine model. The purpose of this study was to compare the Teno Fix with suture repair in a clinical setting.

METHODS: Sixty-seven patients with isolated zone-II flexor tendon injury were randomized to be treated with a Teno Fix or a four-stranded cruciate suture repair. There were eighty-five injured digits: thirty-four were treated with the Teno Fix, and fifty-one served as controls. A modified leinert rehabilitation technique was employed, with active flexion starting at four weeks postoperatively. Patients were followed for six months by blinded observers who determined the range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, pinch and grip strength, and pain score on a verbal scale and assessed swelling and neurologic recovery. Adverse outcomes, including device migration and rupture, were monitored at frequent intervals.

RESULTS: Nine of the fifty-one suture repairs ruptured, whereas none of the Teno Fix repairs ruptured (p < 0.01). Five of the nine ruptures were caused by resistive motion against medical advice. There were no differences between the two groups in terms of range of motion, DASH score, pinch and grip strength, pain, swelling, or neurologic recovery. The Teno Fix group had slightly slower resolution of pain and swelling compared with the control group. Of the patients who were available for follow-up at six months, sixteen of the twenty-four treated with a Teno Fix repair and nineteen of the twenty-seven treated with a control repair had a good or excellent result. One Teno Fix device migrated and extruded secondary to a wound infection. Of all eighty-five digits that were operated on, four were thought to have tendons of inadequate size to accommodate the device and nine were deemed to have inadequate exposure to allow placement of the anchors.

CONCLUSIONS: The Teno Fix is safe and effective for flexor tendon repair if the tendon size and exposure are sufficient. Tendon repairs with the Teno Fix have lower rupture rates and similar functional outcomes when compared with conventional repair, particularly in patients who are non-compliant with the rehabilitation protocol.

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