Recent evolutions in flexor tendon repairs and rehabilitation

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Rehabilitation Medicine

Background:

• Traditional flexor tendon repair guidelines emphasize non-bulky repairs and standard peripheral sutures.
• Established protocols often involve prolonged immobilization and restricted joint positioning post-surgery.

Purpose of the Study:

• To review recent advancements in flexor tendon repair and rehabilitation strategies.
• To evaluate the safety and efficacy of modified surgical and post-operative protocols.

Main Methods:

• Review of recent literature on flexor tendon repair and rehabilitation.
• Analysis of techniques including sparse peripheral sutures, aggressive pulley release, and early active motion.

Main Results:

• Favorable outcomes reported with modified techniques, including minimal repair ruptures and no functional bowstringing.
• New approaches allow for slightly bulky repair sites and aggressive pulley release (e.g., A2, A3, A4 pulleys).
• Shorter splinting with less wrist restriction and early out-of-splint active motion are safe with strong repairs.

Conclusions:

• Recent advancements challenge traditional guidelines regarding repair bulkiness and peripheral suture necessity.
• Aggressive pulley release and early motion protocols are safe and effective for flexor tendon repair.
• These modifications simplify surgical procedures and improve patient rehabilitation outcomes.