The Effect of Flexor Digitorum Profundus Repair Position Relative to Camper Chiasm on Tendon Biomechanics

Mohammad M. Haddara, Eric C. Mitchell, Louis M. Ferreira, Joshua Gillis

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: The purpose of this study was to investigate the impact of repairing a zone II flexor digitorum profundus (FDP) laceration anatomically versus extra-anatomically on tendon loads and work of flexion (WOF). Methods: Twenty digits from 5 cadaveric specimens were tested using an in vitro active finger motion simulator under 2 FDP tendon repair conditions: anatomic and extra-anatomic. Tensile loads in FDP and flexor digitorum superficialis (FDS), WOF, and total active finger range of motion (ROM) were measured using in-line load cells and electromagnetic tracking, respectively. Results: The anatomic repairs had no effect on tendon loads or WOF for either FDP or FDS. The extra-anatomic repairs increased FDP loads by 32% and decreased FDS loads by 9% compared with those in the intact condition. This pattern was similar for WOF following extra-anatomic repairs, which increased FDP WOF by 31% and decreased FDS WOF by 18%. Comparing the 2 repairs, FDP loads and WOF were 25% and 22% greater, respectively, with extra-anatomic repairs compared with anatomic repairs, with no significant change in FDS. Total active ROM was not affected by either repair. Conclusions: In this in vitro cadaveric model, extra-anatomic repairs of FDP increased tendon loads and WOF compared with anatomic repairs. Clinical relevance: On the basis of this study, reconstitution of the anatomic relationship of FDP and FDS at the Camper chiasm during the repair of zone II flexor tendon lacerations is recommended.

Original languageEnglish
Pages (from-to)314.e1-314.e7
JournalJournal of Hand Surgery
Issue number3
StatePublished - Mar 2023
Externally publishedYes


  • Camper chiasm
  • flexor tendon
  • repair
  • tendon load
  • work of flexion


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