Flore Viry MD, Presenter: Nothing to Disclose

Catherine Phan MD, Abstract Co-Author: Nothing to Disclose

Violaine Beauthier, Abstract Co-Author: Nothing to Disclose

Lionel Arrive MD, Abstract Co-Author: Nothing to Disclose

Yves M. Menu MD, Abstract Co-Author: Nothing to Disclose

Anne Miquel, Abstract Co-Author: Nothing to Disclose

To compare contrast enhanced MR and ultrasound (US) performance in differentiating complications after repair of digital flexor tendon as tendon rupture (frank rupture or elongated callus) or adhesions, from normal post operative aspect.

Sixteen consecutive patients with tendon rupture were included to be explored by MR ans US 3 months after surgery. 19 fingers, 25 tendons (16 Flexor Digitorum Profondis, 8 Flexor Digitorum Superficialis in zone 1 or 2 IFSSH and 1 Flexor Pollicis Longus) were explored by MR and US studies. Axial and sagittal spin echo sequences (T1, proton density and T1 with fat saturation and gadolinium injection) were performed. US included dynamic study. US and MR studies were blinded. The MR criteria for rupture was the complete lack of continuity of the tendon hyposignal on axial sequences. Standard of reference was either surgical results in case of reoperation or clinical status assessed by a senior surgeon 6-9 months after surgery.

The average time between surgery and imaging was 130 days (+/-109). Four tendons were reoperated with confirmation of frank rupture,10 had intensive reeducation for peritendinous adhesions and 11 had a normal outcome. MR and US depicted frank tendon ruptures in all 4 cases. False positive MR results for rupture was observed in two tendons and US was false positive for rupture in one of these 2 tendons. In these 2 cases, tendons were controlled very early after surgery (24/40 days). Gadolinium enhancement did not improve MR performance in assessing tendon continuity. In case of continuous tendon, the peritendinous scar tissue was depicted in all MR studies except 4 /11 normal outcome tendons controlled 350 days after surgery. US was more specific for peritendinous adhesions, showing the synchronous mobilisation of tendon and peritendinous tissue only in the 10 cases of peritendinous adhesions. In 2 normal outcome tendons xith suture in zone 1, dynamic US study was technically difficult.

MR and US study are complementary in the assessment of post operative flexor tendon. Special care should be taken in case of early post operative study, since immature connective healing tissue appears as a gap in the tendon continuity, especially in MR study.

MR and US study are complementary in the assessment of post operative finger flexor tendon. Early control car lead to false positive results for tendon rupture.

Viry, F, Phan, C, Beauthier, V, Arrive, L, Menu, Y, Miquel, A, Follow Up of Flexor Tendon Repair in the Hand: MR and US Imaging Assessment.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013120.html