Outcomes of Isolated Digital Flexor Tenolysis: A Systematic Review

Background: Flexor tendon injuries form a significant proportion of hand trauma presentations. Insult to the flexor tendon and surrounding sheath may lead to the formation of adhesions between these structures during the repair process. Tenolysis is a surgical release of these adhesions which requires careful consideration. This systematic review aims to report on the functional outcomes following isolated digital flexor tenolysis. Methods: We searched four online databases in December 2019. Eligibility criteria for studies were: English language; described patients undergoing digital flexor tenolysis; reported functional outcomes such as total active motion (TAM). Five articles were included. The selected studies were of limited quality (level IV evidence). Results: Of the final cohort 79.4% were male. Three studies reported patient age, with a mean age of 36.8 years [4 years to 58 years] in that subset. One hundred and three digits underwent flexor tenolysis only. Mean duration to surgery from the index operation or injury was 15.1 months [2.3 months-240 months]. Average follow-up from the tenolysis procedure was 18.6 months [3 months to 120 months]. Four studies assessing motion via Strickland classification reported 78.9% excellent or good outcomes. The remaining study reported 80% of patients reporting excellent or good motion as per Buck-Gramcko score. The complication rate reported was 15.3%. Conclusions: This review found digital flexor tenolysis significantly improves ROM, however these benefits must be considered in the light of potential complications. A detailed discussion with each individual patient must occur prior to such an undertaking.