Delayed primary flexor tendon repair in zone II injuries: results of using WALANT and controlled true active motion

Early repair of flexor tendon injuries is ideal, but delays are common. We studied the outcomes of flexor tendon repairs delayed from 5 days to 6 months and carried out under wide-awake local anaesthesia with no tourniquet (WALANT). Twenty-four patients (29 fingers) who underwent primary flexor tendon repair on zone II using a four- to six-strand core suture technique, followed by controlled early active motion therapy. Clinical assessments, including total active motion (TAM) and Disabilities of the Arm, Shoulder and Hand, were made 6, 8 and 12 weeks after operation. All outcomes improved significantly over time. At the final assessment, 93% of fingers showed excellent TAM outcomes. Extension deficit was between 5° and 20° in eight of 26 fingers. The results of this study suggest that delayed primary flexor tendon repair under WALANT can achieve excellent functional outcomes, although longer follow-up is needed for extension deficit recovery.Level of evidence: IV.