Anatomy and histomorphology of the flexor digitorum profundus enthesis: Functional implications for tissue engineering and surgery

Jeremy Mortimer, Hamad Alsaykhan, Subashan Vadibeler, Philippa Rust, Jennifer Z Paxton*, Hooper Hand Unit St John's Hospital

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output


The enthesis possesses morphological adaptations across the soft-hard tissue junction which are not fully restored during surgical avulsion repairs. This loss of anatomical structure, highly related to function, contributes to poor clinical outcomes. Investigating the native macro- and micro-structure of a specific enthesis can provide functional and biomechanical insights to develop specialised, novel tissue-engineered therapeutic options and potentially improve current surgical treatments for avulsion injuries.

This study examines the anatomy and histomorphology of the flexor digitorum profundus (FDP) enthesis in 96 fresh-frozen human cadaveric fingers, quantitatively and qualitatively analyzing the shape, size, angle of tendon fibres and histological architecture, and explores differences in sex, finger and distance along the enthesis using linear mixed effects models.

Macroscopically, results showed a consistent trapezoidal insertion shape of 29.29 ± 2.35 mm2 mean surface area, but with significant morphometric size differences influenced primarily by the smaller dimensions of the little finger. Microscopically, a fibrocartilaginous enthesis was apparent with a 30.05 ± 0.72o mean angle of inserting tendon fibres, although regional variation in fibrocartilage and the angle change of tendon fibres before insertion existed.

The implication of these findings on native and specific FDP enthesis function is discussed whilst providing recommendations for optimal FDP enthesis recreation for interfacial tissue engineers and hand surgeons. The study emphasizes the importance of region-specific knowledge whilst also describing methods applicable to assessing any soft tissue insertion.
Original languageEnglish
Article number1032
Number of pages11
JournalBMC Musculoskeletal Disorders
Early online date10 Dec 2021
Publication statusE-pub ahead of print - 10 Dec 2021

Keywords / Materials (for Non-textual outputs)

  • flexor digitorum profundus
  • enthesis
  • anatomy
  • histology
  • interfacial tissue engineering


Dive into the research topics of 'Anatomy and histomorphology of the flexor digitorum profundus enthesis: Functional implications for tissue engineering and surgery'. Together they form a unique fingerprint.

Cite this