A Prospective Randomized Controlled Trial of Controlled Passive Mobilization vs. Place and Active Hold Exercises After Zone 2 Flexor Tendon Repair

Farzad, Maryam; Layeghi, Fereydoun; Asgari, Ali; Ring, David; Karimlou, Masoud; Hosseini, Seyed Ali

doi:10.1142/s0218810414500105

Cited by 26 publications

(22 citation statements)

References 35 publications

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“…This was due to difficulties with access to specialist hand surgery, which is a factor in the South African healthcare system too. In the developed countries of England, 25 Japan 26 and Iran, 28 in specialised hand centres, the majority of patients underwent surgery much sooner: all patients in the study by Caulfield et al 25 had surgery on day 2 post injury.…”

Section: Discussionmentioning

confidence: 99%

Range of movement, power and pinch grip strength post flexor tendon repair

Spark¹,

Godlwana²,

Ntsiea³

2018

SA orthop. j.

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Background: Flexor tendon injuries (FTI) are common hand injuries that pose a challenge to the multidisciplinary team. Despite being the most researched topic in hand literature, the optimal surgical and post-operative treatment of FTI remains unclear and results after flexor tendon repair (FTR) continue to be unpredictable. Purpose: The purpose of this study was to determine the range of movement (ROM), power and pinch grip strength post FTR and to establish factors that may affect these. Method: The study was conducted at an academic hospital in Gauteng, South Africa, between January 2013 and September 2015. At one, three and six months post FTR, the ROM of the injured and contralateral finger(s) were measured. At three and six months post FTR the participants' bilateral power and pinch grip strength were also measured. Results: One hundred and twenty-six participants (n=126) enrolled in the study. There was a drop-out rate of 48%, leaving 65 participants that completed six months' follow-up: 41 males (63%) and 24 females (37%) with mean age of 32 years (SD±10, n=65). Out of 65 participants, 2% (n=1) had an excellent outcome, 32% (n=21) a good outcome, 32% (n=21) a fair outcome and 34% (n=22) a poor outcome with regard to ROM. At six months post FTR the average power grip was 60% (SD±25, n=65) of the unaffected hand, while the average pinch grip was 52% (SD±42, n=65) of the unaffected hand. Sixty-eight per cent (n=44) of patients had post-operative complications: the most common complication was tenodesis/ adhesions (25%, n=16), followed by contracture (22%, n=14). Four patients (6%) had ruptures and 11 (17%) underwent further surgery. Factors that had a positive effect on outcome at six months post FTR were: younger age, no associated injury, less duration between injury and surgery, having controlled active motion instead of passive motion occupational therapy protocol, and not having a language barrier. Injury in zone IV was associated with worse ROM and power grip strength than other zones. Conclusion: Although there were some promising outcomes, during this period participants did not consistently achieve the good or excellent outcomes that are achieved in some developed countries.

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Section: Discussionmentioning

confidence: 99%

Range of movement, power and pinch grip strength post flexor tendon repair

Spark¹,

Godlwana²,

Ntsiea³

2018

SA orthop. j.

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“…Outcome studies allow surgeons and therapists to consider more progressive approaches in their own practice. 39,64,[74][75][76][77] Place and hold exercises have been reported as facilitating greater total active motion, 74,76,77 less flexion contractures, 77 and higher patient satisfaction 77 as compared with passive protocols. Early active motion using the Belfast protocol resulted in significantly higher total active motion 4 weeks after surgery compared with the Kleinert regimen.…”

Section: Motionmentioning

confidence: 99%

Rehabilitation of the Upper Extremity Following Nerve and Tendon Reconstruction: When and How

Novak

Heyde

2015

Seminars in Plastic Surgery

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“…Only few investigations compared EAM with CPM, most of those are retrospective case control studies (Bainbridge et al, 1994, Baktir et al, 1996, Peck et al, 1998, Hoffmann et al, 2008, Frueh et al, 2014. Two randomized controlled trials compared CPM with PAH (Trumble et al, 2010, Farzad et al, 2014. All these studies except one (Peck et al, 1998) suggest better results with the EAM protocol.…”

Section: Rehabilitationmentioning

confidence: 99%

“…Despite the great enthusiasm for modern techniques, one of the best results ever (98% excellent and good) was published from a military hospital using modified Kessler repair (Chow et al, 1987). In addition, modified Kessler repair was used in the first series reporting EAM (Cullen et al, 1989, Small et al, 1989 and in a recent study comparing CPM with PAH as well (Farzad et al, 2014). In a short clinical series excellent results were obtained with a heavy gauge locking two-strand suture combined with aggressive EAM (Hatanaka et al, 2002).…”

Section: Suture Techniquementioning

confidence: 99%

“…However, the contraction of the flexor muscles does not lead to any motion of the fingers, indicating that PAH is not a true EAM regime. In all but one papers (Farzad et al, 2014) PAH was combined with rubber bands. We assessed the pooled results for these active rehabilitation groups and found 88% excellent or good function with true EAM, 88% with EAM combined with the Kleinert's regime and 87% with PAH regimes.…”

Section: Eam Rehabilitationmentioning

confidence: 99%

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Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

Rigó

Haugstvedt

Ludvigsen

et al. 2012

Journal of Plastic Surgery and Hand Surgery

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There is a need for a strong suture technique that allows early active mobilisation after repair of flexor tendons, but the best method has not yet been found. The aim of this study was to compare the modified Kessler suture biomechanically with a newer, two-strand suture. Eighteen porcine tendons were cut and repaired according to either the grasping modified Kessler suture or the combined side-locking loop technique (Yotsumoto) and interlocking horizontal mattress suture (Dona). The specimens were tested linearly to failure. The 2 mm gap force, yield force, ultimate force, stiffness, energy to yield, and energy to failure were all significantly higher (p value = 0.005, 0.003, <0.001, 0.001, 0.004, and 0.001, respectively) in the Yotsumoto-Dona group (median values (IQR): 30.9 (28.1-39.5) N, 82.7 (64.9-114.1) N, 82.7 (76.6-114.1) N, 12.5 (10-14.5) N/mm, 0.45 (0.2-0.5) J, and 0.45 (0.35-0.5) J) than in the modified Kessler group (25.8 (12.2-28.1) N, 35 (24.6-54.4) N, 50.9 (34.4-55.1) N, 7 (5.8-91) N/mm, 0.09 (0.06-0.18) J, and 0.21 (0.18-0.28) J). All Yotsumoto-Dona specimens had a yield force exceeding 35 N, while in the Kessler group only four did. The early yielding rate was 6/9 and 2/9 in the modified Kessler and the Yotsumoto-Dona groups, respectively (p = 0.15). Most of the core sutures failed by breakage, but three Yotsumoto knots loosened. All the simple running and six of the Dona epitendinous sutures failed predominantly by pulling-out, and by breakage at the intersections in three of the latter. The relatively easy two-strand Yotsumoto-Dona suture is likely to withstand the loads of active finger flexion, whereas the modified Kessler suture is probably not.

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A Prospective Randomized Controlled Trial of Controlled Passive Mobilization vs. Place and Active Hold Exercises After Zone 2 Flexor Tendon Repair

Abstract: Place and hold achieves greater motion than controlled passive mobilization after a two-strand repair for zone 2 flexor tendon repairs.

Cited by 26 publications

References 35 publications

Range of movement, power and pinch grip strength post flexor tendon repair

Range of movement, power and pinch grip strength post flexor tendon repair

Rehabilitation of the Upper Extremity Following Nerve and Tendon Reconstruction: When and How

Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

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