Multistrand Tendon Repairs With Early Active Motion Versus 2-Strand Repairs With Passive Motion

Abstract

Objective: To report the results of an audit of repair of zone 2 flexor tendons in 68 digits using two different repair methods and rehabilitation protocols. Materials and Methods: From January 2014 to January 2015, we treated 35 digits in 21 consecutive patients who had complete divisions of flexor tendons in zone 2. All tendon repairs followed an established surgical and rehabilitation protocols. The flexor digitorum profundus (FDP) tendons in 31 fingers and flexor pollicis longus tendons in 4 thumbs were repaired using either 6-strand M-Tang or 4-strand U-Tang methods. In 13 fingers, we vented part of the A2 pulley, and the entire A4 pulley was vented in 5 fingers. Active digital motion started from 4 days post-surgery. In 2013, the same surgical team repaired zone 2 flexor tendons in 25 consecutive patients (33 digits) with a conventional 2-strand modified Kessler repair with a passive motion protocol. Their outcomes were collected as the historical controls. Results: In evaluations of 35 digits with multistrand repair with early active motion 10 to 16 months postsurgery, the outcomes were excellent in 27 (80%), good in 3 (8.5%), fair in 3 (8.5%), and poor in 1 (2.2%) digits according to Strickland and Glogovac criteria. There were no repair ruptures. Four thumbs were all rated as excellent. No bowstringing was found in the 18 fingers, where either a part of the A2 pulley or entire A4 pulley was vented. The outcomes of 33 digits with a modified Kessler repair with passive motion were excellent in 13 (39.3%), good in 9 (27.2%), fair in 4 (12.1%), and poor in 7 (21.1%) digits. Repair ruptures were noted in 6 (18.2%) digits. Conclusions: Multi-strand core repairs with early active motion significantly improve outcomes over a conventional 2-strand repair with early passive motion in zone 2 flexor tendon repair.