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The IFSSH consensus and current guidelines on flexor tendon repairs and reconstruction.

Jin Bo Tang1, Donald Lalonde2, Carlos H Fernandes3

  • 1Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.

The Journal of Hand Surgery, European Volume
|February 4, 2026
PubMed
Summary
This summary is machine-generated.

Updated guidelines for flexor tendon repair and reconstruction emphasize strong repairs with early active flexion. Key recommendations include avoiding peripheral sutures and knot placement within the tendon stumps for improved surgical outcomes.

Keywords:
Flexor tendonearly active flexionoutcomesperipheral suturesprimary repairrehabilitationsecondary reconstructionsix-strand repair

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Area of Science:

  • Hand surgery
  • Orthopedic surgery
  • Tendon repair and reconstruction

Background:

  • Expert consensus from the 16th Congress of the International Federations for Societies for Surgery of the Hand (IFSSH) in 2025 informed these guidelines.
  • Discussion focused on current best practices for primary flexor tendon repair and secondary reconstruction.

Purpose of the Study:

  • To summarize updated guidelines and expert consensus on flexor tendon repair and reconstruction.
  • To provide evidence-based recommendations for improving surgical outcomes in hand surgery.

Main Methods:

  • Consensus development among international hand surgery experts.
  • Review of outcomes from surgical units to support guidelines.
  • Discussion of primary repair and secondary reconstruction techniques.

Main Results:

  • Primary flexor tendon repair guidelines: strong repair methods, early active flexion, no peripheral sutures with six-strand repairs, knots outside tendon stumps, and abandonment of place-and-hold exercises.
  • Secondary flexor tendon reconstruction: one-stage grafting for intact pulleys, staged grafting for pulley reconstruction, and early active motion post-one-stage grafting.

Conclusions:

  • Significant advances in flexor tendon repair and reconstruction continue.
  • Authors highlight critical technical points and global outcomes to enhance surgical results.