Suture knots between tendon stumps may not benefit tendon repairs

et al. 2019

We reviewed outcomes of 230 flexor tendon repairs in 27 thumbs and 203 fingers in Zone 1 and 2 over 7 years. In 2013, we used a 2-strand modified Kessler method followed by passive motion exercise in repairing flexor digitorum profundus tendon injuries in Zone 2 in 30 fingers; 24 fingers were followed, five (26%) had repair ruptures. Between 2014 and 2017, we used a 4- or 6-strand method to repair 111 flexor digitorum profundus tendons in Zone 2, followed by true early active motion. Two had repair ruptures. Among 101 fingers followed over 6 months, two fingers had tenolysis and 87 (87%) good or excellent outcomes. In 2018 to 2019, we used a 6-strand method to repair 42 flexor digitorum profundus tendons in Zone 2 with out-of-splint early active motion. None had repair ruptures or tenolysis. From 2014 to 2019, 27 flexor pollicis longus tendons were repaired in Zone 1 or 2, and 20 fingers had end-to-end flexor digitorum profundus repairs in Zone 1; none had repair ruptures or tenolysis. We conclude that a strong repair and true active motion are necessary for best outcomes of flexor tendon repairs in the thumb and fingers, and out-of-splint true active motion is safe.

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Section: Discussionsupporting

confidence: 91%

Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years

et al. 2019

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“…The peripheral sutures serve to tidy up the repair site and prevent gapping (Tang et al., 2017). The function of the peripheral suture is largely replaced by tensioning the core sutures and the use of multi-strand repairs (Chen et al., 2018; Hay et al., 2018; Kozono et al. 2016; Lalonde, 2017; Lim et al., 2018; Myer and Fowler, 2016; Pan et al., 2017; Wu and Tang, 2014).…”

Section: Discussionmentioning

confidence: 99%

Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers

et al. 2019

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We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8–33 months. We conclude that tensioned multi-strand strong core repairs only require sparse peripheral stitches and are safe for early active flexion. Standard peripheral sutures are not necessary. The core sutures should be properly tensioned to prevent gapping at tendon repair site and pulleys should be sufficiently vented to allow tendon motion. Level of evidence: IV

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“…Second, we do not place the knots in the tendon-stump interface, as we think that this interferes with tendon healing and contributes to gap formation during the early active motion. Recent studies also indicate placement of knots between the two stumps slightly decreases the repair strength (Chang et al., 2018; Chen J, et al., 2018; Hay et al., 2017). We place the knots on the tendon surface, which has not increased adhesion formation.…”

mentioning

confidence: 99%

Infrequent need for tenolysis after flexor tendon repair in zone 2 and true active motion: a four-year experience

2019