A Comparison of Results of Extensor Tendon Repair Followed by Early Controlled Mobilisation Versus Static Immobilisation

Abstract

To compare the functional results of early controlled mobilisation and static immobilisation following repair of extensor tendons, we conducted a comparative study between two centres. In one, a consecutive series of tenorrhaphy patients was treated post-operatively by the dynamic splinting technique. In the other, a consecutive group was treated by static splinting. All patients treated by dynamic splinting were graded excellent within six weeks following surgery; no tendon ruptures occurred and no secondary corrective tendon surgery was required. After static splinting, 40% were graded excellent, 31% good, 29% fair, and none poor; six fingers treated by static splintage subsequently required tenolysis. Following surgical repair of extensor tendons of the hand, patients treated by early controlled motion regain better flexion function in terms of grip strength and pulp-to-palm distance. Dynamic splinting is a more effective technique than static splinting in the prevention of extensor lag.

Sonographic Differentiation of Digital Tendon Rupture From Adhesive Scarring After Primary Surgical Repair

“…8,9 Adhesive scarring between tendon, synovial sheath, and adjacent ligaments after primary flexor and extensor tendon repair is reported to occur in 20% and 17% of patients, respectively. [1][2][3][4] The sonographic appearance of a normal tendon shows a fibrillar pattern of parallel hyperechoic lines when viewed in the longitudinal plane (Fig. 1).…”

“…1,2 Two percent of primary extensor tendon repairs will rupture and adhesive scarring is reported to occur in 2% to 17% of patients. 3,4 Clinically patients with tendon rupture or adhesive scarring may manifest similar or identical findings. Differentiating tendon rupture from adhesive scarring is beneficial because early surgical re-exploration often results in better outcomes than delayed surgical intervention.…”

Extensor Tendon Injuries

“…Subsequently, many authors retrospectively demonstrated successful outcomes using these protocols. 7,11,12,20 More recently, several studies have prospectively investigated the differences between static immobilization, early dynamic mobilization, and early active mobilization protocols.…”

Effect of Interleukin-10 Overexpression on the Properties of Healing Tendon in a Murine Patellar Tendon Model

“…11 The majority of research in the area of flexor and extensor tendon repair in the hand has focused on the development of improved suture repair techniques and the enhancement of postoperative rehabilitation protocols allowing early motion. 4,5,[12][13][14][15][16][17][18][19][20][21][22][23] These improved surgical and rehabilitation methods have led to better clinical outcomes, but scarring and adhesion formation remain important complications. 1,2 Even with the best surgical techniques and the optimal therapeutic protocols, results can be unpredictable.…”

“…[1][2][3][4][5][6][7][8][9][10] Whereas the initial formation of scar between tendon ends provides physical continuity at the site of disruption, proliferation of scar between the tendon and adjacent tissues is undesirable because these attachments can impede the gliding mechanism of the tendon, whether sheathed or not. 11 The majority of research in the area of flexor and extensor tendon repair in the hand has focused on the development of improved suture repair techniques and the enhancement of postoperative rehabilitation protocols allowing early motion.…”