Treatment of flexor tendon reconstruction failures: multicentric experience with Brunelli active tendon implant

  • A. Poggetti
  • M. NoviEmail author
  • M. Rosati
  • D. Ciclamini
  • M. Scaglione
  • B. Battiston
Original Article • HAND - TRAUMA



Secondary repair of flexor tendon injuries remain a challenging procedure for hand surgeons. Usually, secondary reconstruction should be performed by staged approach. When the tendon and pulley integrity are intact, tenolysis may be the first surgical option. One-/two-stage tendon grafts are suggested when the integrity of flexor tendon is compromised. Active tendon implants (Brunelli prostheses) may represent an efficient option in patients with a poor prognosis, as well as whenever classical techniques fail. Due to lack of literature about this second-line treatment, the authors present the experience of two different orthopedic departments with the permanent active tendon implant.

Materials and method

Nineteen consecutive patients with failed previous flexor tendons repairs were treated with active tendon implants between 2000 and 2011. The functional outcome of the patients was examined with a mean follow-up of 5.6 years, using Strickland assessment and QuickDASH.


In 16 cases, the tendon implants were well tolerated and patients resulted satisfied with a QuickDASH score less than 33. Strickland score was fair to excellent in 10 patients. We registered adhesion complications in 3 cases.


We can conclude that these prostheses represent an alternative to biological reconstructions and a potentially permanent procedure in complicated flexor tendon injuries.

Level of evidence

Multicentric case series, Level IV.


Flexor tendons Tendon injury Flexor tendon repairs Flexor tendon prosthesis 


Compliance with ethical standards

Conflict of interest

No funds were received in support of this study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Ist Orthopaedic and Traumatology Unit, University Hospital of PisaPisaItaly
  2. 2.UOC Traumatology - Reconstructive Microsurgery, Department of Orthopaedics and TraumatologyCTO Hospital in TurinTurinItaly

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