Principles for Achieving Predictable Outcomes in Flexor Tendon Repair

Flexor tendon injuries require surgical repair. Early repair is optimal, but staged repair may be indicated for delayed presentations. Zone II flexor tendon injuries are the most difficult to achieve acceptable outcomes and require special attention for appropriate repair. Surgical techniques to repair flexor tendons have evolved over the past several decades and principles include core strand repair using at least a 4 strand technique, epitendinous suture to add strength and gliding properties, and pulley venting. Early postoperative active range of motion within the first 3 to 5 days of surgery is essential for optimizing outcomes.