A systematic review of patient outcomes for primary pediatric flexor tendon repairs

Area of Science:

• Orthopedic Surgery
• Pediatric Hand Surgery
• Musculoskeletal Research

Background:

• Literature on pediatric flexor tendon repairs is limited.
• Diverse repair techniques and rehabilitation protocols exist for pediatric flexor tendons.
• A systematic review is needed to investigate outcomes of primary pediatric flexor tendon repairs.

Purpose of the Study:

• To systematically review and investigate the functional outcomes of primary flexor tendon repairs in pediatric patients.
• To synthesize evidence on the effectiveness of different surgical and rehabilitation approaches for pediatric flexor tendon injuries.

Main Methods:

• A systematic literature search was conducted across MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases.
• Studies included pediatric patients (<18 years) with primary flexor tendon repair and documented functional outcomes, adhering to PRISMA guidelines.
• Quality assessment was performed using the Newcastle-Ottawa Scale, and the study was registered with PROSPERO.

Main Results:

• The review included 20 articles covering 577 patients and 748 injured digits, with lacerations (often from glass) being the most common injury mechanism.
• The modified Kessler technique was most common for repairs, with a mix of immobilization and early active/passive rehabilitation protocols employed post-operatively.
• Functional outcomes were reported for 466 digits, with a high proportion achieving excellent (306) or good (132) results, and a low rate of tendon ruptures (15).

Conclusions:

• Primary repair of pediatric flexor tendons demonstrates low complication rates and favorable functional outcomes.
• Despite heterogeneity in surgical and post-operative protocols, evidence suggests good results can be expected.
• This review provides low-level evidence supporting current practices in pediatric flexor tendon repair.