Suture Anchor Fixation for Zone 1 Flexor Digitorum Profundus Avulsion Injuries: A Systematic Review of Outcomes and Complications.

Abstract

There is a paucity of literature on clinical outcomes of suture anchor repair for zone 1 flexor digitorum profundus (FDP) injury. The purpose of this study was to summarize the clinical results and complications of suture anchor repairs for zone 1 (FDP) tendon injuries across available peer-reviewed literature. A systematic search in October 2025 was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to screen for peer-reviewed randomized controlled trials, retrospective and prospective studies, and case series reporting outcomes and complications of patients who underwent zone 1 flexor tendon repair with suture anchors. Eight articles (5 retrospective cohort studies, 3 case series) met inclusion criteria. A total of 161 patients underwent FDP repair with suture anchor fixation. Complications and poor outcomes were reported in 44 (27%) cases. Postoperative stiffness or decreased range of motion was the most common complication, confirmed in 27 (17%) cases. Infection, anchor migration/exposure/protrusion, nail deformity, and tendon repair failure occurred in 7 (4%), 4 (2%), 2 (1%), and 4 (2%) cases, respectively. Suture anchor repair of FDP avulsion injuries demonstrates lower rates of nail deformity and infection than those of pullout buttons; however, it still presents complications that are both familiar and unique compared with classic techniques. These results can be used to help counsel patients on the risks of surgery via suture anchor fixation.