The effect of adding active flexion to modified Kleinert regime on outcomes for zone 1 to 3 flexor tendon repairs. A prospective randomized trial

Section: Discussionmentioning

confidence: 99%

Sonographic study of repair, gapping and tendon bowstringing after primary flexor digitorum profundus repair in zone 2

Reissner

Zechmann-Mueller

Klein

et al. 2018

“…As such, for the less experienced surgeon, the extra-tendinous modification may be the better repair method to use. Currently, there are many other suture configurations using looped sutures (Moriya et al, 2015(Moriya et al, , 2016a(Moriya et al, , 2016bPan et al, 2017;Rigó et al, 2017;Savage and Tang, 2016;Tang, 2007;Wu and Tang, 2014;Zhou et al, 2017). Further studies might include comparing these techniques in repeated cyclic loading conditions or different suture materials.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of modified Lim/Tsai tendon repairs with intra- and extra-tendinous knots

Chang

Wong

Tay

2018

We compared the Lim/Tsai tendon repair technique using an extra-tendinous knot with modification using an intra-tendinous knot. The ultimate tensile strength, load to 2 mm gap force, stiffness, mode of failure, location of failure, and time taken to repair each tendon were recorded during a single cycle loading test in 20 tendons with each repair method. We found that the ultimate tensile strength and 2 mm gap force of the modified Lim/Tsai repair with an extra-tendinous knot (56 SD 5 N and 14 SD 2 N, respectively) were statistically significantly higher than that of the modified Lim/Tsai repair with intra-tendinous knot (51 SD 7 N and 11 SD 2 N, respectively). We conclude that the modified Lim/Tsai repair with extra-tendinous knot is stronger, despite having the same number of core strands.

“…Stronger suture materials without increased diameter are desirable. Fiberwire, however, seems to be too stiff (Giesen et al, 2017(Giesen et al, , 2018Hay et al, 2017;Rigó et al, 2017), and many surgeons do not consider it suitable for zone 2 flexor tendon repair.…”

Section: Future Perspectivesmentioning

confidence: 99%

Recent evolutions in flexor tendon repairs and rehabilitation

Tang

2018

This article reviews some recent advancements in repair and rehabilitation of the flexor tendons. These include placing sparse or no peripheral suture when the core suture is strong and sufficiently tensioned, allowing the repair site to be slightly bulky, aggressively releasing the pulleys (including the entire A2 pulley or both the A3 and A4 pulleys when necessary), placing a shorter splint with less restricted wrist positioning, and allowing out-of-splint active motion. The reported outcomes have been favourable with few or no repair ruptures and no function-disturbing tendon bowstringing. These changes favour easier surgeries. The recent reports have cause to re-evaluate long-held guidelines of a non-bulky repair site and the necessity of a standard peripheral suture. Emerging understanding posits that minor clinically noticeable tendon bowstringing does not affect hand function, and that free wrist positioning and out-of-splint motion are safe when strong surgical repairs are used and the pulleys are properly released.