Study of the experimental biomechanics of tendon repair with immediate active mobilization

1986 ◽  
Vol 8 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Ch Mabit ◽  
J M Bellaubre ◽  
J L Charissoux ◽  
M Caix
Keyword(s):  
Tendon Repair ◽  
Active Mobilization ◽  
Experimental Biomechanics

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion

2018 ◽  
Vol 44 (4) ◽  
pp. 354-360 ◽  
Author(s):  
Koji Moriya ◽  
Takea Yoshizu ◽  
Naoto Tsubokawa ◽  
Hiroko Narisawa ◽  
Yutaka Maki
Keyword(s):  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV

Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C

2016 ◽  
Vol 41 (8) ◽  
pp. 822-828 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
K. Hara ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Clinical Results ◽  
The Other ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
A2 Pulley ◽  
Active Mobilization ◽  
Finger Motion

We report the results of complete release of the entire A2 pulley after zone 2C flexor tendon repair followed by early postoperative active mobilization in seven fingers and their comparisons with 33 fingers with partial A2 pulley release. In seven fingers, release of the entire A2 pulley was necessary to allow free gliding of the repairs in five fingers and complete release of both the A2 and C1 pulleys was necessary in two. No bowstringing was clinically evident in any finger. Two fingers required tenolysis. Using Tang’s criteria, the function of two digits was ranked as excellent, four good and one fair; there was no failure. The functional return in these seven fingers was similar with that in 33 fingers with partial A2 pulley release; in these patients only one finger required tenolysis. Our results support the suggestion that release of the entire A2 pulley together with the adjacent C1 pulley does not clinically affect finger motion or cause tendon bowstringing, provided that the other pulleys are left intact. Level of evidence: IV

Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

2016 ◽  
Vol 41 (8) ◽  
pp. 793-801 ◽  
Author(s):  
I. Z. Rigo ◽  
M. Røkkum
Keyword(s):  
Flexor Tendon ◽  
Linear Regression Analysis ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Multiple Linear Regression Analysis ◽  
Level Of Evidence ◽  
Pulley System ◽  
Skeletal Injury ◽  
Active Mobilization

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3–98), respectively. Using the Strickland criteria, ‘excellent’ or ‘good’ function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath–pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert’s regime. Level of evidence: III

Finger zone II flexor tendon repair in children (5–10 years of age) using three ‘figure of eight’ sutures followed by immediate active mobilization

2011 ◽  
Vol 36 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Mohammad M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Final Outcome ◽  
Study Group ◽  
Flexor Tendon Repair ◽  
Active Mobilization ◽  
Zone Ii ◽  
Adult Rehabilitation

For children between 5–10 years of age with zone II flexor tendon lacerations, the literature recommends a modified early mobilization programme under the supervision of a hand therapist but the fingers are immobilized between physiotherapy sessions. We report on a series of children between 5–10 years of age with flexor tendon lacerations (n = 54 fingers) in zone II repaired with a six-strand core suture (three separate ‘figure of eight’ sutures) and actively mobilized immediately after surgery similar to adult rehabilitation programmes with no immobilization between the physiotherapy sessions. The average follow-up for the study group was 13 months (range 7–25 months). There were no ruptures. The final outcome was excellent in 46 fingers (85%) and good in the remaining eight fingers (15%) using the Strickland–Glogovac criteria.

Outcomes of repair of the lacerated A2 pulley with extensor retinaculum during primary flexor tendon repair

2017 ◽  
Vol 42 (9) ◽  
pp. 903-908 ◽  
Author(s):  
A. El-Shebly ◽  
M. El Fahar ◽  
H. Mohammed ◽  
A. Bahaa Eldin
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Extensor Retinaculum ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Fair Result ◽  
Active Range Of Motion ◽  
A2 Pulley ◽  
Active Mobilization ◽  
A1 Pulley

We report outcomes of repairing the lacerated A2 pulley with extensor retinaculum graft in ten patients (ten fingers) during primary flexor tendon repair in zone 2. Complete A2 pulley lacerations were found in eight fingers and partial A2 pulley laceration in two. We extended the laceration in the sheath to the middle of the A4 or A1 pulley to allow tendon repair with a four-strand core suture. The A2 pulley was reconstructed with an extensor retinaculum graft. All patients followed the early controlled active mobilization protocol and recovered active range of motion at the interphalangeal joints without major extension deficits. Using the Strickland and Glogovac criteria, there were four excellent, five good and one fair result. One finger was graded excellent, eight good, and one fair according to Tang’s criteria. No clinical bowstringing was observed. We conclude that extensive pulley lacerations reconstructed with extensor retinaculum primarily ensure functional recovery after tendon repair. Level of evidence: IV

A New Type of Flexor Tendon Repair

1995 ◽  
Vol 20 (5) ◽  
pp. 578-583 ◽  
Author(s):  
R. J. N. WILLIAMS ◽  
A. A. AMIS
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Cyclic Loads ◽  
Failure Strength ◽  
Flexor Tendon Repair ◽  
Ultimate Failure ◽  
A2 Pulley ◽  
Active Mobilization ◽  
New Type ◽  
Better Than

Experiments were performed to evaluate biomechanical aspects of the performance of a “deep-biting peripheral suture” for flexor tendon repair, either when used alone or with a square or modified Kessler core stitch, and the technique was compared to the Kleinert repair. Tests included progressively increasing cyclic loads, force to pull the repair into the A2 pulley, and ultimate failure strength. 50% of the Kleinert repairs failed under 30 N cyclic loading, while 100% of the DBPS plus Kessler core stitch repairs survived. There was no discernable difference in gliding function or repair bulk between these sutures, but ultimate strength increased significantly with the DBPS repairs. We concluded that the DBPS plus Kessler-type core stitch will survive active mobilization better than the Kleinert method.

Primary Flexor Tendon Repair in Zone 1

2000 ◽  
Vol 25 (1) ◽  
pp. 78-84 ◽  
Author(s):  
N. S. MOIEMEN ◽  
D. ELLIOT
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Range Of Movement ◽  
Realistic Assessment ◽  
Distal Interphalangeal ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Distal Tendon

This paper presents an analysis of the results of repair of 102 complete flexor tendon disruptions in zone 1 which were rehabilitated by an early active mobilization technique during a 7 year period from 1992 to 1998. These injuries were subdivided into: distal tendon divisions requiring reinsertion; more proximal tendon divisions but still distal to the A4 pulley; tendon divisions under or just proximal to the A4 pulley; and closed avulsions of the flexor digitorum profundus tendon from the distal phalanx. Assessment by Strickland’s original criteria showed good and excellent results of 64%, 60%, 55% and 67% respectively in the four groups. However, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment of the affect of this injury on DIP joint function, with good and excellent results of only 50%, 46%, 50% and 22% respectively in the four groups.

Sign in / Sign up

Export Citation Format

Share Document