Six-Strand Core Repairs Ensure Early Active Motion and Satisfactory Functional Return of the Flexor Pollicis Longus Tendon

Abstract

Objective: To report outcomes of repair of flexor pollicis longus (FPL) tendon in 23 thumbs followed by early active thumb motion. Materials and Methods: We used a 6-strand repair with very loose epitenon suture for lacerated FPL tendons in 23 thumbs. These patients were treated between January 2014 and May 2015. All patients were repaired primarily in the day of injury or within the first week after injury. The FPL was exposed through a Bruner’s incision, and the tendon was repaired with either a 6-strand M-Tang repair (17 thumbs) using 4-0 looped suture and a 6-strand repair method made of 3 groups of modified Kessler repair (6 thumbs) using 4-0 Ethilon suture. After surgery, the thumbs were immobilized for 3 to 4 days, and active motion was initiated after that. The patient was encouraged to move the thumb interphalangeal joint to about ½ of the total motion range in the first 1 to 3 weeks after repair. Then the patient proceeded to full range of active motion around the end of week 3. Results: All patients were followed for 6 to 19 months with the mean follow-up of 14 months. The functional recovery at the final follow-up was graded according to Strickland criteria. Fourteen thumbs were rated excellent, 4 good, and 3 fair. No thumbs were rated poor. No rupture of the FPL was recorded. The overall excellent and good rate was 86%, and the rate of fair results was 14%. Conclusions: We found that a 6-strand core suture repair is sufficient for early active motion of the repaired FPL tendon. With early active motion, the recovery of the FPL function is usually excellent and good. We found there is no risk of repair rupture with a 6-strand core suture repair. We only used very loosely added 2 or 3 stitches of epitenon suture. We found that adding complex epitenon suture is unnecessary with a strong 6-strand repair for the FPL tendon.