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

Pan, Zhang Jun; Yun, Xu; Pan, Lei; Chen, Jing

doi:10.1177/1753193419826493

Cited by 34 publications

(32 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A tendon repair must be strong enough to withstand forces and movement without being compromised during rehabilitation (Edsfeldt et al., 2015). In our study, all repair groups demonstrated a mean ultimate tensile strength of more than 75 N, which is well above the load required (about 30–40 N) for early active motion after end-to-end primary flexor tendon repair (Pan et al., 2019a; Edsfeldt et al., 2015).…”

Section: Discussionsupporting

confidence: 49%

“…Early controlled active flexion or extension following either primary repair or tendon transfers reduce adhesion and scarring, improve range of joint motion, and speeds up return to work (Doi et al., 2008; Moriya et al., 2019; Pan et al., 2019a, 2019b, 2020; Rath, 2008). A tendon repair must be strong enough to withstand forces and movement without being compromised during rehabilitation (Edsfeldt et al., 2015).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The strengths of one-, two-, and three-weave Pulvertaft tendon repairs

Choke

Rung

McGrouther

et al. 2020

J Hand Surg Eur Vol

View full text Add to dashboard Cite

We tested the tensile strength of the proximal juncture of tendon grafts with Pulvertaft tendon repairs in 18 cadaveric digital flexor tendons. These tendons were divided into three groups of six: single, two, or three weaves. Each of the interlacing weaves was secured with eight anchoring sutures. The specimens were loaded in a biomechanical tester until failure. The ultimate tensile strength did not show any significant differences across all three groups with statistical power of 0.77. The mean tendon elongation before repair failure showed significant difference at 10 mm (standard deviation (SD) 2), 16 mm (SD 3), and 15 mm (SD 3), respectively. All specimens failed by intra-tendinous pull-out of the weaves. We conclude that the two-weave Pulvertaft construct demonstrated comparable tensile strength to three weaves and tendon elongation was similar when two or three weaves were used.

show abstract

Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

The strengths of one-, two-, and three-weave Pulvertaft tendon repairs

Choke

Rung

McGrouther

et al. 2020

J Hand Surg Eur Vol

View full text Add to dashboard Cite

show abstract

“…Peripheral suture exposure may also lead to adhesion formation and increase gliding resistance during early active motion. [3] The authors did not perform running peripheral sutures for the patients included in this study. As Tang [8] reported that peripheral sutures can be rather sparse or even absent, we did not prefer to use epitendinous sutures.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] However, a suture exposure due to complex peripheral suture may lead to adhesion formation and increase gliding resistance during early active motion. [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

Tenolysis rate after zone 2 flexor tendon repairs

Ci̇van¹,

Gürsoy

Cavit

et al. 2020

Jt Dis Relat Surg

View full text Add to dashboard Cite

Tendon adhesion to surrounding tissues after tendon repair, which is difficult to prevent in clinical practice, is the most common complication reported after tendon repair. [1] Thus, reducing the incidence of adhesion after tendon repair without affecting tendon healing has become a popular research focus. New surgical and rehabilitation techniques are improving the results while an unanimity for the best method has not been obtained. Tendon motion after tendon repair is important to avoid adhesions. Depending on the tendon repair strength, early passive or active flexion exercises may start immediately after the repair. Tendon gapping during or after the repair may deteriorate the results. The peripheral sutures serve to tidy up the repair site and prevent gapping. [2] However, a suture exposure due to complex peripheral suture may lead to adhesion formation and increase gliding resistance during early active motion. [3] Venting pulleys may also decrease the adhesion rate after flexor tendon repair. On the contrary to traditional knowledge about preserving A4 pulley, some authors recommend venting A4 pulley to Objectives: This study aims to evaluate the tenolysis rates of zone 2 flexor digitorum profundus (FDP) with flexor digitorum superficialis (FDS) tendon repairs using four-strand technique and early passive motion exercises. Patients and methods: In this retrospective study, we performed zone 2 flexor tendon repairs in 149 patients (117 males, 32 females, mean age 33.3±12.9 years; range, 13 to 72 years) (82 right and 67 left hands) between November 2014 and January 2019. A total of 194 FDP and FDS tendons were repaired primarily by using modified Kessler and Bunnell methods. Patients underwent pure passive motion protocols after surgery according to modified Duran's protocol. No active flexion components were added until postoperative fourth week. Results: Twenty-three out of 149 patients and 28 out of 194 fingers (14.43%) had tenolysis. There was no significant relationship between the number of operated fingers, gender, and tenolysis rate (p=0.836, p=0.584, respectively). Conclusion: The repair of the FDP with FDS tendon increases the tenolysis rate in zone 2. The tenolysis rate does not change according to the number or distribution of injured fingers and gender of the patient.

show abstract

“…The practice has changed greatly over past 15 years, and venting of the critical pulley is as important as implementing a strong repair technique such as a 6-strand repairs [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. All publications of clinical outcomes in zone 2 in recent years indicate such as need [ 5 , [12] , [13] , [14] , [15] , [16] , [17] ]. The outcomes from our units also indicate the need, besides the reports from Europe and North America [ 12 , 13 , 16 ].…”

mentioning

confidence: 99%