Flexor tendon repair using the two-strand side-locking loop technique to tolerate aggressive active mobilization immediately after surgery

2007 ◽  
Vol 22 (10) ◽  
pp. 1083-1087 ◽  
Author(s):  
Suguru Kuwata ◽  
Ryuji Mori ◽  
Tadahiko Yotsumoto ◽  
Yuji Uchio
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Mobilization ◽  
Loop Technique

Aggressive active mobilization following zone II flexor tendon repair using a two-strand heavy-gauge locking loop technique

2002 ◽  
Vol 7 (4) ◽  
pp. 457-461 ◽  
Author(s):  
Hitoshi Hatanaka ◽  
Tetsuo Kojima ◽  
Tomoyuki Mizoguchi ◽  
Yoshifumi Ueshin
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Mobilization ◽  
Loop Technique ◽  
Zone Ii

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

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.

Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations

2014 ◽  
Vol 40 (3) ◽  
pp. 250-258 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
Y. Maki ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Total Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We evaluated the factors influencing outcomes of flexor tendon repair in 112 fingers using a six-strand suture with the Yoshizu #1 technique and early postoperative active mobilization in 101 consecutive patients. A total of 32 fingers had injuries in Zone I, 78 in Zone II, and two in Zone III. The mean follow-up period was 6 months; 16 patients (19 fingers) participated in long-term follow-up of 2 to 16 years. The total active motion was 230° SD 29°; it correlated negatively with age. The total active motion was 231° SD 28° after repair of the lacerated flexor digitorum superficialis tendon, and was 205° SD 37° after excision of the flexor digitorum superficialis tendon ends ( p = 0.0093). A total of 19 fingers showed no significant increases in total active motion more than 2 years after surgery. The rupture rate was 5.4% in our patients and related to surgeons’ level of expertise. Five out of six ruptured tendons were repaired by inexperienced surgeons. Level of Evidence IV

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