LENGTHENING THE LOCKING LOOP REPAIR FOR ZONE 2 FLEXOR TENDON LACERATION AND PARTIAL LATERAL RELEASE OF THE TENDON SHEATH

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 125-129 ◽  
Author(s):  
Hithoshi Hatanaka ◽  
Tetsuo Kojima ◽  
Tomoyuki Miyagi ◽  
Tomoyuki Mizoguchi ◽  
Yoshifumi Ueshin
Keyword(s):  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Lateral Release ◽  
Flexor Tendon Repair ◽  
Loop Technique ◽  
Tendon Laceration

The authors present the clinical outcomes of nine zone 2 flexor tendon repairs using a locking loop technique (i.e. the Modified Pennington technique). The locking loops were located approximately 10 mm away from the lacerated tendon ends to "lengthen" the locking loop repair, as experimentally and clinically recommended. The partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, was performed not only to locate the sutures but also to allow a full range of motion of the repair without catching on the tendon sheath, as clinically recommended. All the patients were followed up for six months or more except for one. All digits were evaluated as excellent or good at the final follow-up by the original Strickland criteria. No rupture occurred and no bowstring of the flexor tendon was observed. The clinical outcomes of the current study indicate that "lengthening" the locking loop repair is effective for zone 2 flexor tendon repair and that the partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, does not result in the bowstring of the flexor tendon.

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

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

The Direct Midlateral Approach with Lateral Enlargement of the Pulley System for Repair of Flexor Tendons in Fingers

1996 ◽  
Vol 21 (4) ◽  
pp. 463-468 ◽  
Author(s):  
A. MESSINA ◽  
J. C. MESSINA
Keyword(s):  
Flexor Tendon ◽  
Skin Flap ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Flexor Tendon Repair ◽  
Anterior Compartment ◽  
Pulley System ◽  
Neurovascular Pedicle ◽  
Anchoring System ◽  
Palmar Skin

The direct midlateral approach and the lateral enlarging procedure of the pulley system have been utilized in our service since 1972. The incision runs directly behind the neurovascular pedicle, which is left in the palmar skin flap of the anterior compartment of the finger, in order to ensure its blood supply and sensibility. The transverse digital lamina of Landsmeer’s skin anchoring system and Cleland’s ligament are preserved and are used to perform a lateral enlargement of the pulleys after tendon repair. The technique allows wide surgical exposure of the digital fibro-osseous tunnel, enlargement and reconstruction of the pulley system and tendon sheath, flexor tendon repair (using the technique of choice) and reduces postoperative impingement in zone 2.

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.

A comparative analysis of the outcome of flexor tendon repair in the index and little fingers: does the little finger fare worse?

2011 ◽  
Vol 37 (1) ◽  
pp. 20-26 ◽  
Author(s):  
K. S. Orkar ◽  
C. Watts ◽  
F. C. Iwuagwu
Keyword(s):  
Flexor Tendon ◽  
Index Finger ◽  
Tendon Repair ◽  
Flexion Contracture ◽  
Hand Therapy ◽  
Flexor Tendon Repair ◽  
Single Digit ◽  
Significant Difference ◽  
Little Finger

The clinical and hand therapy notes of 180 patients who had single digit flexor tendon repairs in zones I and II from January 2000 to December 2004 were reviewed. Data from 60 index and 108 little fingers at 5 weeks, 8 weeks and 12 weeks follow-up visits were included. In zone I injuries, there was a statistically significant difference in flexion contracture (worse in the little fingers ) at all follow-up points. Although the range of motion and percentage of patients in the excellent category of the Strickland and Glogovac criteria were greater in the index finger group than the little finger for zone I and II injuries, these differences were not statistically significant. The rupture rate was also higher in the little finger group.

Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation

1989 ◽  
Vol 14 (4) ◽  
pp. 392-395
Author(s):  
K. W. CULLEN ◽  
PAMELA TOLHURST ◽  
D. LANG ◽  
R. E. PAGE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Adult Patients ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.

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

Efficacy of Adcon-T/N After Primary Flexor Tendon Repair in Zone II: A Controlled Clinical Trial

2003 ◽  
Vol 28 (2) ◽  
pp. 113-115 ◽  
Author(s):  
A. GOLASH ◽  
A. KAY ◽  
J. G. WARNER ◽  
F. PECK ◽  
J. S. WATSON ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Flexor Tendon Repair ◽  
Double Blind ◽  
Active Motion ◽  
Zone Ii

A prospective double-blind, randomized, controlled clinical trial was conducted to assess the use of ADCON-T/N after flexor tendon repair in Zone II. Forty-five patients with 82 flexor tendon repairs in 50 digits completed the study. ADCON-T/N was injected into the tendon sheath after tenorrhaphy in the experimental group while the control group was not treated with ADCON-T/N. ADCON-T/N had no statistically significant effect on total active motion at 3, 6 and 12 months but the time taken to achieve the final range of motion was significantly shorter in treated patients. ADCON-treated patients had a higher rupture rate but this was not significant.

Providing Quantitative Feedback When Teaching Tendon Repair: A New Tool

2005 ◽  
Vol 30 (6) ◽  
pp. 626-632 ◽  
Author(s):  
J. C. BERSCHBACK ◽  
P. C. AMADIO ◽  
C. ZHAO ◽  
M. E. ZOBITZ ◽  
K. N. AN
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Flexor Tendon Repair ◽  
Hand Surgeon ◽  
Repair Technique ◽  
Academic Medical ◽  
Biomechanical Parameters ◽  
Set Up

Flexor tendon repair remains one of the more difficult technical tasks facing the hand surgeon. A good repair must be both strong and able to glide smoothly through the tendon sheath. The purpose of this study is to present a model that allows surgeons to improve their technique of flexor tendon repair by receiving feedback on these important biomechanical parameters. The set-up requires testing equipment found in most biomechanical laboratories and should be available in many academic medical centres. Preliminary data suggest that receiving feedback about the strength and smoothness of a flexor tendon repair may be a very useful tool in helping surgeons improve the overall quality of their tendon repair technique.

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