A Comparative Study of Two Methods of Controlled Mobilization of Flexor Tendon Repairs in Zone 2

Abstract

This prospective study compares subjects following primary repair of flexor tendons in zone 2 using either controlled active motion or a modified Kleinert regime. A matched pairs design was employed, subjects being matched for gender, age and injury characteristics. Twenty-six pairs of subjects with 92 tendon injuries in 52 digits were assessed 12 weeks postoperatively in respect of range of motion and dehiscence. Outcomes were defined using the Strickland criteria. No statistically significant differences in respect of range of motion were demonstrated between the groups. Incidence of rupture, however, was significantly less in the modified Kleinert group (7.7%) than in the controlled active motion group (46%).

The biomechanical analysis of a tendon fixation device for flexor tendon repair

“…[2][3][4][5][6][7][8][9] Modern multistrand repairs and the addition of circumferential sutures have increased the tensile strength of repairs, 10 -13 suggesting that they are adequate to sustain forces in early active mobilization. 8,9,14,15 Many of these biomechanical tests have used the study of forces in FDP tendons during carpal tunnel release by Schuind et al 16 as a benchmark. Several investigators, however, feel that measurement of forces in tendons without prior trauma overlooks increases in work of flexion from postsurgical edema and adhesion formation.…”

“…Several investigators, however, feel that measurement of forces in tendons without prior trauma overlooks increases in work of flexion from postsurgical edema and adhesion formation. 16 -19 In the clinical setting underestimation of forces after trauma and noncompliance during rehabilitation 20 may explain rupture rates up to 46% of the time, 9 with most between 5% and 10%. [3][4][5][6][7][8]14,15,[21][22][23][24][25] In addition to rupture early mobilization may lead to gapping with adhesion formation and diminished tendon glide and function.…”

Gliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model

“…[1][2][3] Improvements in operative and rehabilitation techniques have advanced treatment, but many tenorrhaphies continue to fail, either from a rupture at the tendon repair site or by the formation of restrictive adhesions. 4 -10 The relationship between early mobilization and improved clinical results after flexor tendon repair in zone II has been documented in many studies.…”

“…Many high-strength repairs are also high-friction repairs, which may explain why clinical reports of patients treated with stronger tendon repairs have shown little of the anticipated improvement in clinical outcome. 3,18,33 These stronger repairs may, by their bulk or some other effect, impede tendon gliding and thus, although strong enough to permit gentle active motion, may not result in improved gliding as compared with passive mobilization of weaker, lower-friction repairs. The ideal would, of course, be a strong repair that did not bring with it the burden of increased friction.…”

Characterization of adenovirus-mediated gene transfer in rabbit flexor tendons

“…3 Conversely attempts to decrease adhesions, such as early active range of motion, often lead to tendon rupture. 4,5 Recently biologic augmentation of flexor tendon healing has been explored as a solution to this dilemma. If the biology of flexor tendon healing can be altered to provide a stronger repair, then earlier and more aggressive therapy potentially could be started.…”