Factors Influencing Prognosis After Direct Repair of the Flexor Pollicis Longus Tendon: Multivariate Regression Model Analysis

Abstract

Few studies have focused on the relevance of early motion exercise on repair of the flexor pollicis longus tendon. We evaluated 29 patients with flexor pollicis longus tendon lacerations treated by direct end-to-end suture, and statistically assessed the clinical factors that influenced the results by using a multivariate logistic regression model. Association with age, vascular damage and timing of repair did not affect the results. Patients with flexor pollicis longus tendon lacerations in zone II or with the tendon stumps retracted proximally had a significantly high risk of unsatisfactory results. Postoperative passive flexion and active extension exercise using rubber bands significantly decreased the risk of unsatisfactory results in these conditions. Results of this study indicate that early postoperative motion is useful after every FPL tendon repair, particularly in patients with zone II laceration or retraction of the proximal tendon stump.

Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture

“…In 1999, we attributed Murphy's observation to the greater retraction of the FPL muscle than that of the finger flexors and presumed that the higher rupture rate of FPL primary repairs was due to the consequent increase in tension at the repair site. Recently, the presence of a retracted proximal end of the FPL tendon at surgery has been shown to be detrimental to the outcome of the tendon repair (Kasashima et al, 2002). When retraction is obvious at surgery, proximal tendon lengthening within the muscle (Le Viet, 1986;Rouhier, 1950) or by 'Z' lengthening of the tendon at the musculo-tendinous junction (Nigst and Me´gevand, 1956;Vigliani and Martinelli, 1981) may improve the results.…”

“…(2) Early active mob n ( strand core sutures and simple circumferential repair, albeit in small numbers of patients (Table 3) (Baer et al, 2003;Kasashima et al, 2002). These studies may identify a factor which is currently given little attention because of concentration on stronger sutures, namely the quality of the rehabilitative service.…”

Clinical Outcomes Associated with Flexor Tendon Repair

“…More recently, they reported 0% rupture rate in 48 patients with strengthened core and peripheral sutures [7]. Other reports include those from Percival and Sykes [28], Noonan and Blair [29], Nunley et al [30], Fitoussi et al [32], and Kasashima et al [33]. Reported results of FPL repairs are detailed in Table 2.…”

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

“…From previous papers age, smoking, soft tissue damage, zone 2 injury, multiple finger injuries, delay of surgery, associated FDS and nerve injuries and immobilization are known risk factors for suboptimal functional results after flexor tendon surgery (Table 4) ( McFarlane et al, 1968, Kasashima et al, 2002, Elhassan et al, 2006, Trumble et al, 2010. We investigated a considerably larger number of fingers (patients) and included crush injuries in the analyses as well.…”