Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol:...

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Flexor tendon injuries in Zones 1 and 2 of the hand and thumb require effective surgical repair.
• Previous methods, like the 2-strand modified Kessler, had high rupture rates (26%).
• Advancements in repair techniques and rehabilitation protocols are crucial for optimal patient outcomes.

Purpose of the Study:

• To evaluate the outcomes of different flexor tendon repair techniques and rehabilitation protocols.
• To determine the safety and efficacy of early active motion in flexor tendon repair recovery.
• To compare the success rates of various surgical methods for flexor digitorum profundus and flexor pollicis longus tendons.

Main Methods:

• Review of 230 flexor tendon repairs (27 thumbs, 203 fingers) in Zones 1 and 2 over seven years.
• Comparison of repair techniques: 2-strand vs. 4- or 6-strand methods.
• Analysis of rehabilitation protocols: passive motion, early active motion with splinting, and early active motion without splinting.

Main Results:

• The 2-strand method had a 26% rupture rate, while 4- or 6-strand methods with early active motion showed significantly lower rupture rates (2/111).
• 87% of patients undergoing 4- or 6-strand repairs with early active motion achieved good or excellent outcomes.
• No repair ruptures or tenolysis were reported with 6-strand repairs and out-of-splint early active motion, or with Zone 1 repairs.

Conclusions:

• A strong flexor tendon repair (4- or 6-strand) is essential for successful outcomes.
• True early active motion, particularly out-of-splint, is safe and promotes better recovery.
• Combining robust surgical repair with early active mobilization optimizes functional recovery in flexor tendon injuries.