Secondary Flexor Tendon Reconstruction: Protocol for a Systematic Review and Meta-Analysis

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Regenerative Medicine

Background:

• Flexor tendon injuries of the hand and wrist often require primary repair.
• Delayed presentations or repair failures necessitate secondary tendon reconstruction using grafts.
• Suboptimal outcomes like stiffness can impact daily living and employment.

Purpose of the Study:

• To systematically evaluate current evidence on secondary flexor tendon reconstruction outcomes.
• To determine functional results, complications, patient-reported outcome measures (PROMS), and costs.
• To compare different grafting techniques and surgeon seniority.

Main Methods:

• PROSPERO-registered systematic review and meta-analysis protocol.
• Literature search from 2000 to present, including all languages.
• Screening by two independent reviewers, bias assessment using Cochrane tools, and potential meta-analysis.

Main Results:

• The review will analyze outcomes of intrasynovial vs. extrasynovial grafting.
• Comparison of graft weaving at the wrist and palm for single- and two-stage reconstructions.
• Primary outcome: functional active range of motion; secondary outcomes: complications, PROMS, resource use.

Conclusions:

• Secondary flexor tendon reconstruction is crucial for cases unsuitable for primary repair.
• This review will provide a comprehensive summary of the best available evidence.
• Findings will aid in more accurate patient counseling and identify research gaps.