Avoiding flexor tendon repair rupture with intraoperative total active movement examination

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Surgical Innovation

Background:

• Wide-awake anesthesia enables intraoperative Total Active Movement examination (iTAMe) for flexor tendon repairs.
• iTAMe allows direct observation of tendon repair integrity during active movement.
• This technique aims to reduce postoperative tendon rupture rates by addressing intraoperative issues.

Purpose of the Study:

• To evaluate the tendon rupture rate in patients undergoing wide-awake flexor tendon repair with iTAMe.
• To assess the effectiveness of iTAMe in identifying and correcting intraoperative gapping.

Main Methods:

• Retrospective chart review of 102 consecutive patients undergoing wide-awake flexor tendon repair.
• iTAMe performed by hand surgeons between 1998 and 2008.
• Analysis of intraoperative gapping and postoperative rupture rates.

Main Results:

• Intraoperative gapping was observed in 7 patients, and re-repair eliminated gapping, with no subsequent ruptures.
• Overall tendon rupture rate was 3.3% (4/122 tendons) and patient rupture rate was 4.4% (3/68 patients).
• All ruptures occurred due to accidental forceful movements, not with adherence to postoperative instructions.

Conclusions:

• Flexor tendon core sutures can gap during active movement if tied too loosely.
• iTAMe is a valuable tool for intraoperative detection and repair of tendon gapping.
• Repairing identified gaps intraoperatively can decrease postoperative tendon rupture rates.