Case report| Volume 65, ISSUE 2, P264-266, February 2012

One-stage treatment of delayed ‘jersey finger’ by z-step lengthening of the flexor digitorum profundus tendon at the wrist


      The authors report the case of a 19-year-old female with delayed presentation of a type II ‘jersey finger’ of the fourth dominant digit. A surgical approach was performed, revealing a retracted flexor digitorum profundus tendon within a still patent sheath. The resulting loss of tendon length overruled any possibility of direct reinsertion of the tendon. A lengthening “Z-step” tendinoplasty was then performed on the tendon at the wrist, thus enabling reinsertion at the base of the distal phalanx. The patient then underwent conventional splinting and physiotherapy. Total Active Motion was measured at 220° with a 6-month follow-up. Even though there is no clear consensus concerning management of such cases, different techniques have been described, such as one- or two-stage grafting, or tenotomy at the musculotendinous junction. Lengthening tendinoplasties have been applied by certain authors but only to the flexor pollicis longus tendon. To our knowledge, this is the only reported case of lengthening Z-step applied to a long digit for the repair of type II ‘jersey finger’ lesions. The satisfactory functional and cosmetic outcome encourages us to consider this one-stage technique in other select cases, in order to gather more formal evidence.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Leddy J.P.
        • Packer J.W.
        Avulsion of the profundus tendon insertion in athletes.
        J Hand Surg Am. 1977; 2: 66-69
        • Jennings E.R.
        • Yeager G.H.
        Barbwire tendon suture; clinical experience with thirty flexor tendons.
        AMA Arch Surg. 1955; 70: 566-569
        • Bonin N.
        • Obert L.
        • Jeunet L.
        • Garbuio P.
        • Tropet Y.
        Reinsertion of the flexor tendon using a suture anchor: prospective study using early active motion.
        Chir Main. 2003; 22: 305-311
        • Elliot D.
        • Amadio P.
        • An K.N.
        • et al.
        IFSSH flexor tendon committee report.
        J Hand Surg Br. 2005; 30: 100-116
        • Durand S.
        • Oberlin C.
        • Macquillan A.
        FDP to FDP hemi-tendon transfer–a new technique for delayed repair of the flexor digitorum profundus in zones I and II of the finger.
        J Hand Surg Eur Vol. 2010 Oct; 35: 677-678
        • Rouhier G.
        Restoration of the long flexor tendon of the thumb without sacrificing the primary tendon.
        J Chir (Paris). 1950; 66: 537-542
        • Leviet D.
        Flexor tendon lengthening by tenotomy at the musculotendinous junction.
        Ann Plast Surg. 1986; 17: 239-246
        • Vigliani F.
        • Martinelli B.
        Repair of rupture of flexor pollicis longus by “Z” lengthening at the wrist.
        Ital J Orthop Traumatol. 1981; 7: 171-179
        • Guimberteau J.C.
        • Panconi B.
        • Boileau R.
        Mesovascularized island flexor tendon: new concepts and techniques for flexor tendon salvage surgery.
        Plast Reconstr Surg. 1993; 92: 888-903
        • Guimberteau J.C.
        • Bakhach J.
        • Panconi B.
        • Rouzaud S.
        A fresh look at vascularized flexor tendon transfers: concept, technical aspects and results.
        J Plast Reconstr Aesthet Surg. 2007; 60: 793-810