Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation

Abstract

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.

Flexor Tenorrhaphy Using Absorbable Suture Materials

“…This study has some limitations. The tendon repair methods and exercise regimens are not exactly the same in our study and Cullen's report [ 6 ]. The grade of the surgeons may not be similar between Cullen and the authors; but the skill of the surgeon was not a factor in this study because all of the repairs were performed by the senior authors.…”

“…According to studies on flexor tendon repair using nonabsorbable sutures, the repair rupture rate has been shown to vary from 2 to 10% [ 9 - 12 ]. Cullen et al [ 6 ] reported a rupture rate of 5.3%, and Caulfield et al [ 10 ] reported a rupture rate of 2% using nonabsorbable sutures. The results of the present study showed that the rupture rate was similar, and the ROM was also satisfactory, in flexor tendon repairs using absorbable sutures compared to the conventional methods using nonabsorbable suture materials ( Table 3 ).…”

“…In addition, in our study, tenolysis was required in only one patient due to tendon adhesion, and the follow-up results showed recovery of normal ROM. In Cullen's report [ 6 ], 2 patients required tenolysis and showed a fair recovery of ROM 4 months after the secondary operation. In this study, no increase in the complication rate was found in the flexor tendon repair using absorbable suture materials, and functional outcomes were also satisfactory.…”

“…For comparing flexor tendon repair using nonabsorbable sutures with that of absorbable sutures, we referred to a study by Cullen et al [ 6 ] for calculating the rupture rate as a percentage, assessing range of motion (ROM), complications, and rehabilitation methods. Similar to the Cullen's study [ 6 ], we analyzed the results of this study according to a retrospective review of the patients' charts, and the results were evaluated using the records of the evaluation of ROM at the final treatment.…”

“…On postoperative day 1, dynamic active exercises for the fingers were performed with a dorsal splint protecting the wrist and without the assistance of rubber bands. The rehabilitation process consisted of active extension and active flexion according to early active motion protocols [ 6 , 7 ]. The patients were strictly advised not to passively stretch the repaired tendons, not to remove the splint unless instructed, and avoid holding the hand in a dependent position.…”