Advances in the healing of flexor tendon injuries

Sammer, Douglas M.; Chung, Kevin C.

doi:10.1111/wrr.12161

Cited by 16 publications

(16 citation statements)

References 68 publications

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“…Although early active mobilisation for rehabilitation post flexor tendon repair is more prominently supported by current medical evidence 7 , a recent United States (US) survey, to evaluate current management trends, found that only 50.5% (207 of 410) of surgeons opt for the use of an early active protocol, whilst the remaining 49.5% (203 of 410) still prefer an early passive protocol 7 . A lack of an established 'gold standard' in rehabilitation of a repaired flexor tendon 3 , has led many therapists currently in practice to combine existing concepts from multiple sources to create combination protocols, that meet patient and context needs 8 . With no conclusive evidence around optimal rehabilitation protocols for this complex injury, there is an ongoing need for research to address the poor functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study

Naude¹,

Klerk²

2019

S. Afr. j. occup. ther.

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Introduction: Flexor tendon injuries remain one of the most difficult hand injuries to manage post-operatively. Early active mobilisation protocols are considered 'best practice' internationally but have not been well researched in the developing country context. The feasibility of such research, and use of these protocols, need to be determined by considering the potential for improved functional outcomes for patients, together with various contextual and resource challenges. Purpose: To explore aspects of feasibility related to the recruitment, consent and retention rates in consideration of a future definitive Randomised Control Trail. In addition, preliminary results of an early active therapy protocol compared to an early passive therapy protocol were reported on, together with patient satisfaction and demographics. Methods: A parallel randomised pilot trial design was used. Thirty-one participants were recruited into one of two therapy groups (active or passive). Fourteen of these participants completed their therapy and eight-week assessments including: Total Active Motion, grip strength, the Michigan Hand Questionnaire and the Smith Hand Function Evaluation. 95% Confidence intervals examined feasibility data. Non-parametric data analysis was done primarily using medians and ranges. Results: Feasibility results of 37% recruitment rate, 97% consent rate and 45% retention rate, did not meet the criteria for success, deeming a trial in the present design, not feasible. Discussion: Due to the dearth of research from public health clinical settings in developing countries, this study contributes rich contextual data, but the challenges discussed need to be addressed before further research will achieve success.

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Section: Introductionmentioning

confidence: 99%

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study

Naude¹,

Klerk²

2019

S. Afr. j. occup. ther.

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“…Despite intensive research activity on these topics, little clinical evidence exists except for the controlled mobilization, which is a type of biophysical stimulation. None of the other regenerative medicine approaches has been implemented in human clinical trials or clinical practice to date (Sammer andChung, 2014, Yang et al, 2013).…”

Section: Repair Of Flexor Tendon Injuriesmentioning

confidence: 99%

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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“…Both follow similar stages to other tissues including inflammation lasting 48-72 h, fibroblast proliferation, collagen production for 3-4 weeks, and remodeling involving cross-linking and reduction of type III collagen with fiber reorientation ( 3 ). Extrinsic healing is characterized by rapid influx of fibroblasts from the peritendinous tissues, which favors the formation of adhesions, and intrinsic healing occurs through fibroblasts originating in the endotendon, without the formation of adhesions and which by early mobilization stimulates the synovial pumps, with a higher resistance on the suture line ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Improving flexor tendon gliding by using the combination of carboxymethylcellulose‑polyethylene oxide on murine model

et al. 2021

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The current approach to flexor tendon injuries is complex and is no longer limited to suturing techniques. Strategies for improving hand function currently include rehabilitation protocols, appropriate suturing materials and techniques, changing the gliding surface by using lubricants and providing growth factors. One product, originally used in spinal surgery, has been shown to be effective in preventing postoperative adhesions. It is a combination of carboxymethylcellulose and polyethylene oxide-Dynavisc ® (FzioMed, Inc.). The aim of the present study was to test the effect of Dynavisc ® on acute injuries of the intrasynovial flexor tendons in the prevention of postoperative adhesions and the improvement of functional results. The study was performed on 20 Wistar rats distributed in two groups. The control group, represented by 10 rats, in which after the reconstruction of the flexor tendon, the peritendinous area was injected with saline solution and the study group, in which the peritendinous area was injected with a single administration of the lubricating gel, Dynavisc ® (carboxymethylcellulose and polyethylene oxide). At 4 and 12 weeks, the rats were sacrificed and tissue biopsy consisted of tendon fragments and adjacent tissue. The evaluation of the results was performed by measuring the adhesion score and observing histological parameters. The presence of important adhesions was found in the control group compared with the group treated with Dynavisc ® , where a supple and smooth tendon, with significantly fewer adhesions were found. The differences between the two groups were significant, thus indicating the efficiency of the lubricant in preventing adhesions. This study supported the important role of Dynavisc ® in the regeneration of the tendon and the peritendinous structures, by limiting aberrant fibrous proliferation in the regeneration process and helping to build a peritendinous space.

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Advances in the healing of flexor tendon injuries

Cited by 16 publications

References 68 publications

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study

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

Improving flexor tendon gliding by using the combination of carboxymethylcellulose‑polyethylene oxide on murine model

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