Investigating the effects of flexor tendon shortening on active range of motion after finger tendon repair.

Evaluation of surgical effects is often done using simple cadaver experimentation. This study uses a robotic testbed to estimate the best-case clinical outcomes of flexor tendon shortening during repair surgery on cadaver hands. Nine fresh-frozen cadaver subjects were connected to an extrinsic index finger robotic muscle testbed and measurement system. The flexor digitorum profundus tendons were severed and surgically repaired at different shortening levels. The index finger's extrinsic tendons were robotically actuated using Hill-type muscle models to emulate the muscle force-length relationships. Extensor muscles were then activated to estimate the active range of motion (ROM) of the all-finger joints after surgery. The effects of metacarpophalangeal (MCP) joint extension limits and extensor muscle activation were also investigated. The resulting interphalangeal joint ROM was clinically graded. Active ROM of the finger decreases as tendon shortening increases ( ηp2=0.92 ), like passive ROM. This results in a clinical reduction of functionality grade from excellent to good at 10 mm of shortening. Blocking MCP joint ROM and extensor activation also showed significant effects on recovered ROM ( ηp2=0.72 and 0.86). Significant two-way interactions were also observed between shortening and MCP joint blocking ( ηp2=0.80 ) and between shortening and extensor activation ( ηp2=0.78 ). Results support clinical recommendations of limiting shortening to 10 mm. While this article provides additional experimental evidence for current surgical recommendations, it also validates a new robotic-cadaver methodology for predicting active hand recovery in terms of clinical measurements.