A Comparison of Post-Operative Mobilization of Flexor Tendon Repairs with “Passive Flexion–Active Extension” and “Controlled Active Motion” Techniques

1994 ◽  
Vol 19 (4) ◽  
pp. 517-521 ◽  
Author(s):  
L. C. BAINBRIDGE ◽  
C. ROBERTSON ◽  
D. GILLIES ◽  
D. ELLIOT
Keyword(s):  
Comparative Study ◽  
Range Of Motion ◽  
Flexor Tendon ◽  
Active Motion ◽  
Rupture Rate ◽  
Passive Flexion ◽  
Extensor Lag

We report a comparative study of the outcome of flexor tendon repairs mobilized by either a “passive flexion-active extension” or a “controlled active motion” regimen. We show that the controlled active motion regimen conferred significant benefits on the final range of motion and extensor lag. The rupture rate was raised with “controlled active motion” but this was not greater than levels reported by other authors using “passive flexion-active extension” regimens.

A Comparative Study of Two Methods of Controlled Mobilization of Flexor Tendon Repairs in Zone 2

1998 ◽  
Vol 23 (1) ◽  
pp. 41-45 ◽  
Author(s):  
F H. PECK ◽  
C. A. BÜCHER ◽  
J. S. WATSON ◽  
A. ROE
Keyword(s):  
Comparative Study ◽  
Prospective Study ◽  
Range Of Motion ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Injuries ◽  
Matched Pairs ◽  
Motion Group ◽  
Active Motion ◽  
Injury Characteristics

This prospective study compares subjects following primary repair of flexor tendons in zone 2 using either controlled active motion or a modified Kleinert regime. A matched pairs design was employed, subjects being matched for gender, age and injury characteristics. Twenty-six pairs of subjects with 92 tendon injuries in 52 digits were assessed 12 weeks postoperatively in respect of range of motion and dehiscence. Outcomes were defined using the Strickland criteria. No statistically significant differences in respect of range of motion were demonstrated between the groups. Incidence of rupture, however, was significantly less in the modified Kleinert group (7.7%) than in the controlled active motion group (46%).

Clinical Outcomes After Aggressive Active Early Motion and Modified Kleinert Regimens: Comparison of 2 Consecutive Cohorts

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Kaisa Jokinen ◽  
Arja Häkkinen ◽  
Toni Luokkala ◽  
Teemu Karjalainen
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Hand Grip Strength ◽  
Active Motion ◽  
Hand Grip ◽  
Active Range Of Motion

Background Modern multistrand repairs can withstand forces present in active flexion exercises, and this may improve the outcomes of flexor tendon repairs. We developed a simple home-based exercise regimen with free wrist and intrinsic minus splint aimed at facilitating the gliding of the flexor tendons and compared the outcomes with the modified Kleinert regimen used previously in the same institution. Methods We searched the hospital database to identify flexor tendon repair performed before and after the new regimen was implemented and invited all patients to participate. The primary outcome was total active range of motion, and secondary outcomes were Disabilities of Arm, Shoulder, and Hand; grip strength; globally perceived function; and the quality of life. Results The active range of motion was comparable between the groups (mean difference = 14; 95% confidence interval [CI], −8 to 36; P = .22). Disabilities of Arm, Shoulder, and Hand; grip strength; global perceived function; and health-related quality of life were also comparable between the groups. There was 1 (5.3%) rupture in the modified Kleinert group and 4 (15.4%) in the early active motion group (relative risk = 0.3; 95% CI, 0.04-2.5; P = .3). Conclusions Increasing active gliding with a free wrist and intrinsic minus splint did not improve the clinical outcomes after flexor tendon injury at a mean of 38-month follow-up.

The rupture rate of acute flexor tendon repairs mobilised by the controlled active motion regimen

1994 ◽  
Vol 19 (1_suppl) ◽  
pp. 38-38
Author(s):  
N. S. Moiemen ◽  
D. Elliot ◽  
A. F. S. Flemming ◽  
S. B. Harris ◽  
A. J. Foster
Keyword(s):  
Flexor Tendon ◽  
Active Motion ◽  
Rupture Rate

The Aetiology of Acute Rupture of Flexor Tendon Repairs in Zones 1 and 2 of the Fingers During Early Mobilization

1999 ◽  
Vol 24 (3) ◽  
pp. 275-280 ◽  
Author(s):  
S. B. HARRIS ◽  
D. HARRIS ◽  
A. J. FOSTER ◽  
D. ELLIOT
Keyword(s):  
Tendon Rupture ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Active Motion ◽  
Rupture Rate ◽  
Active Flexion ◽  
Flexor Tendon Injuries ◽  
Acute Rupture ◽  
Flexor Tendon Rupture

Five hundred and eight patients with 840 acute complete flexor tendon injuries in 605 fingers in zones 1 and 2 underwent surgery and postoperative mobilization in a controlled or early active motion (active flexion-active extension) regimen over a period of 7.5 years. Sixty-eight patients with 79 finger flexor divisions who did not complete the rehabilitation programme were excluded. Of the 440 patients with 728 complete tendon divisions in 526 fingers included in the study, 23 patients ruptured 28 tendon repair(s) in 23 fingers, an overall rupture rate of 4%. One hundred and twenty-nine fingers with zone 1 injuries had a rupture rate of 5%. Three hundred and ninety-seven fingers with zone 2 injuries had a rupture rate of 4%. This study analyses the 23 patients with flexor tendon rupture(s) to identify causative factors. In approximately half of these patients, tendon rupture followed acts of stupidity. The implications of this are discussed. There was no significant relationship between tendon rupture and the age or sex of the patients, smoking or delay between injury and tendon repair and there was no particular prevalence of zone 2C level injuries among the fingers in which tendon rupture occurred.

Long term results of early active extension and passive flexion mobilization following one-stage tendon grafting for neglected injuries of the flexor digitorum profundus in children

2011 ◽  
Vol 36 (4) ◽  
pp. 303-307 ◽  
Author(s):  
Hiroshi Yamazaki ◽  
Hiroyuki Kato ◽  
Shigeharu Uchiyama ◽  
Norimasa Iwasaki ◽  
Hisamitsu Ishikura ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Long Term Results ◽  
Flexor Digitorum Profundus ◽  
Postoperative Rehabilitation ◽  
Active Motion ◽  
One Stage ◽  
Paediatric Patients ◽  
Passive Flexion ◽  
Flexor Digitorum

We retrospectively reviewed the long-term clinical outcomes of one-stage flexor tendon grafting for seven paediatric patients with isolated flexor digitorum profundus (FDP) tendon injuries in Zones 1 or 2. Free tendon grafts (one palmaris longus tendons and six plantaris tendons) were used for reconstruction by Pulvertaft’s procedure. The ages of the patients at reconstruction ranged from 7 to 15 (mean 11) years. The time from injury to surgery ranged from three to 78 (mean 25) months. These patients were followed up from 2.5 to 21 years after surgery (mean 8.5 years). All cases were started on early active extension and passive flexion according to the modified Kleinert mobilization for postoperative rehabilitation. The mean active motion after surgery was 49° (range 20–80°) for the DIP joints and 106° (range 95–110°) for the PIP joints. The total active range of motion was on average 237° (range 195–275°). Excellent results were achieved in five patients, good in one, and fair in one. Growth arrest of the distal phalanx was seen in one patient. One-stage flexor tendon grafting in paediatric patients combined with early controlled mobilization can be used to reconstruct neglected isolated ruptures of the FDP tendon with satisfactory results.

Autonomous Patient-Controlled Mobilization Protocol After Flexor Tendon Repair: A Case Series

Hand ◽  
2020 ◽  
pp. 155894472096496
Author(s):  
Bárbara Gómez ◽  
María Rodríguez ◽  
Luis García
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Case Series ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Early Return ◽  
The Mean

Background: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. Methods: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. Results: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). Conclusion: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

A Prospective Study of Flexor Tendon Repair in Zone 5

1998 ◽  
Vol 23 (5) ◽  
pp. 642-648 ◽  
Author(s):  
N. W. YII ◽  
M. URBAN ◽  
D. ELLIOT
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Active Motion ◽  
Flexor Tendons ◽  
Active Flexion ◽  
A Prospective Study ◽  
Flexor Digitorum

A prospective study of postoperative mobilization of flexor tendon repairs in zone 5 was conducted over a 2-year period between 1994 and 1996 using a controlled active motion (active extension - active flexion) regimen of mobilization. Fifty-two patients, who had a total of 151 flexor digitorum superficialis (FDS) and 103 flexor digitorum profundus (FDP) divisions, were available for review at a mean follow-up of 10 months. Of the 161 fingers with division of one or both flexor tendons, 66% exhibited independent FDS function and 90% achieved good or excellent results of digital range of motion. No rupture of an FDP tendon repair occurred during the study period. The data allowed us to define a new method of classifying the results of treatment of these injuries in terms of the injured wrists as a whole and not simply as a series of isolated observations for each individual finger with divided flexor tendons. The results of recovery of independent FDS action and range of finger movement achieved for injuries in which the flexors of all four fingers had been divided indicate a statistically significant interdependence of injuries of finger flexors of adjacent fingers at the wrist. Multivariate analysis showed the presence of a “spaghetti wrist” injury to have a significant adverse effect on the recovery of the independent FDS action but not on the recovery of the digital range of motion.

scholarly journals Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

2021 ◽  
Author(s):  
Assaf Kadar ◽  
Alon Fainzack ◽  
Mordechai Vigler
Keyword(s):  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Injury ◽  
Motion Simulation ◽  
Gap Formation ◽  
Active Motion ◽  
Flexor Tendon Injury ◽  
Low Profile ◽  
Flexion Extension ◽  
Load To Failure

Abstract BackgroundFlexor tendon injuries pose many challenges for the treating surgeon, the principal of which is creating a strong enough repair to allow early active motion, preserving a low-profile of the repair to prevent buckling and subsequent pulley venting. A main concern is that a low-profile repair is prone to gap formation and repair failure. The Dynamic Tendon Grip (DTG™) all suture staple device claims to allow a strong and low-profile repair of the flexor tendon. The purpose of this study is to test the effects of the DTG™ device in early active motion simulation on range of motion, load to failure and gap formation and to compare it to traditional suturing technique. MethodsTwelve fresh-frozen cadaveric fingers were assigned to two groups: DTG™ device (n=9) and traditional suturing (double Kessler 4-core suture and a peripheral suture, n=3). The deep flexor was incised and repaired in zone 2, and active motion simulation was carried out with a cyclic flexion-extension machine. Finger range of motion and gap formation were measured, as well as load to failure and method of repair failure. ResultsFollowing motion simulation, ROM decreased from 244.0 ± 9.9° to 234.5 ± 5.8° for the DTG™ device compared to 234.67 ± 6.51° to 211.67 ± 10.50° for traditional suturing. The DTG™ repair demonstrated gap formation of 0.93 ± 0.18 mm in 3 of 8 specimens after applying 1 kg load, which negated after load removal. Load to failure averaged 7.8 ± 2.36 kg for DTG™ and 6.76 ± 4.10 kg for the traditional repair. Repair failure occurred as the suture material broke for the DTG™ array and at the knot level for the traditional repair.ConclusionsThe DTG™ all-suture stapling concept achieved a strong low-profile repair in zone 2 flexor tendon injury after active motion simulation. Further clinical studies will be needed to determine the effectiveness of this device compared to traditional techniques.

scholarly journals Management of Flexor Pollicis Longus Injury - Experience in BSMMU

2021 ◽  
Vol 12 (1) ◽  
pp. 20-26
Author(s):  
Md Ashraful Islam ◽  
Ismat Ara Begum ◽  
Monisha Datta ◽  
Suvendu Kumar Banik ◽  
Shahidullah ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Subjective Assessment ◽  
Pinch Strength ◽  
Flexor Pollicis Longus ◽  
Mean Power ◽  
Active Motion ◽  
Power Grip ◽  
Rupture Rate ◽  
Pinch Grip

Anatomic consideration: Flexor pollicis longus (FPL) tendon arises from volar aspect of middle third of radial shaft and from the lateral aspect of interosseous membrane. The anterior interosseous branch of median nerve innervates the muscle in the proximal/mid forearm. Blood supply is predominantly from radial artery. Abstract Purpose: The purpose of this study was to evaluate the results of repair and one stage reconstruction of FPL injury and to find out complications and rupture rate and effectiveness of repair and reconstruction. Method: This retrospective review was carried out in Bangabandhu Sheikh Mujib Medical University from January 2015 to December 2018. 30 consecutive patients were enrolled in the study. 4 strands core suture with simple circumferential suture were used for repair and reconstruction. Tendon transfer was done in few cases. Power grip, active and passive range of motion, American Society for Surgery of the Hand criteria and Buck-Gramcko criteria were used for outcome assessment. Results: Out of 30 patients, 20 (67%) were male and 10 (33%) were female. Mean age was 30 years. Mean follow up period was 1.5 years. All cases were due to various type of cut injuries. In subjective assessment 40% patients achieved excellent, 50% good, 10% fair results. Our rupture rate was 0%. Mean power grip, pinch grip strength of index and key pinch strength were 87.5%, 68.18% and 86.66% respectively from contralateral normal hand. Active range of motion of IP joint was 64.28% of normal side. Conclusions: Use of 4 strands core sutures and early active motion give good to excellent results in 90% cases of repair, reconstruction and tendon transfer in FPL injuries with 0% rupture rate J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 20-26

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