Clinical Outcomes of Flexor Tenolysis Following Zone 2-3 Flexor Tendon Repair: A Retrospective Review

Adhesions and finger stiffness are common complications following zone 2 and zone 3 flexor tendon repairs. When active finger flexion recovery has plateaued, flexor tenolysis can be an effective surgical option. However, literature reporting the outcomes of flexor tenolysis is scarce.

Medical records were reviewed for patients who underwent flexor tenolysis after primary repair over a 10-year period. Clinical outcomes, including active range of motion, total active motion, pain scores, and composite flexion, were assessed after surgery.

68 digits in 31 patients met study criteria. At the 12-week follow-up, total active motion improved considerably from 146.8° to 183.5°, and active range of motion at the proximal interphalangeal joint increased from 46.1° to 60.0°. Composite flexion improved from 2.5 to 1.9 cm from the distal palmar crease. Half of the digits achieved excellent or good outcomes based on the Modified Strickland score. Reoperation was the most common complication. Flexor tendon rupture occurred in 3% of cases.

Flexor tenolysis can be effective for improving motion following tendon repair, particularly in primary procedures and isolated tendon injuries. Revision tenolysis, dual tendon repairs, and associated digital nerve injuries were associated with poorer outcomes.

Flexor tenolysis offers meaningful, though modest, improvements in motion for patients with stiffness after zone 2-3 flexor tendon repair, reinforcing its role as a valuable secondary procedure when recovery plateaus. This study further clarifies which patient and injury characteristics predict better or poorer outcomes, helping surgeons counsel patients more accurately and tailor expectations for recovery.