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.
AmadioPCHunterJMJaegerSHWehbeMASchneiderLH. The effect of vincular injury on the results of flexor tendon surgery in zone 2. J Hand Surg Am. 1985, 10: 626–32.
2.
BeckerHOrakFDuponselleE. Early active motion following a beveled technique of flexor tendon repair: report on fifty cases. J Hand Surg Am. 1979, 4: 454–60.
3.
BrandsmaJWOttenhoff-De JongeMW. Flexor digitorum superficialis tendon transfer for intrinsic replacement. Long-term results and the effect on donor fingers. J Hand Surg Br. 1992, 17: 625–8.
4.
CullenKWTolhurstPLangDPageRE. Flexor tendon repair in zone 2 followed by controlled active mobilisation. J Hand Surg Br. 1989, 14: 392–5.
5.
DuranRJHouserRG. Controlled passive motion following flexor tendon repair in zones 2 and 3. In: American Academy of Orthopaedic Surgeons Symposium on tendon surgery in the hand. St. Louis, CV Mosby, 1975: 105–14.
6.
DyCJHernandez-SoriaAMaYRobertsTRDaluiskiA. Complications after flexor tendon repair: a systematic review and meta-analysis. J Hand Surg Am. 2012, 37: 543–51.
ElliotDHarrisSB. The assessment of flexor tendon function after primary tendon repair. Hand Clin. 2003, 19: 495–503.
9.
ElliotDGiesenT. Avoidance of unfavourable results following primary flexor tendon surgery. Indian J Plast Surg. 2013, 46: 312–24.
10.
GaultDT. A review of repaired flexor tendons. J Hand Surg Br. 1987, 12: 321–5.
11.
HwangMDPettroneSTrumbleTE. Work of flexion related to different suture materials after flexor digitorum profundus and flexor digitorum superficialis tendon repair in zone II: a biomechanical study. J Hand Surg Am. 2009, 34: 700–4.
12.
ImaedaTTohSWadaT. Validation of the Japanese Society for Surgery of the Hand Version of the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH-JSSH) questionnaire. J Orthop Sci. 2006, 11: 248–53.
13.
JonesPAlexanderCJStewartJLynskeyN. Idiopathic osteoarthritis and contracture: causal implications. Ann Rheum Dis. 2005, 64: 226–8.
14.
KitsisCKWadePJKriklerSJParsonsNKNichollsLK. Controlled active motion following primary flexor tendon repair: a prospective study over 9 years. J Hand Surg Br. 1998, 23: 344–9.
15.
KleinertHEKutzJEAtasoyEStormoA. Primary repair of flexor tendons. Orthop Clin North Am. 1973, 4: 865–76.
16.
KusanoNYoshizuTMakiY. Experimental study of two new flexor tendon suture techniques for postoperative early active flexion exercises. J Hand Surg Br. 1999, 24: 152–6.
17.
MoiemenNSElliotD. Primary flexor tendon repair in zone 1. J Hand Surg Br. 2000, 25: 78–84.
18.
OrkarKSWattsCIwuagwuFC. A comparative analysis of the outcome of flexor tendon repair in the index and little fingers: does the little finger fare worse?J Hand Surg Eur. 2012, 37: 20–6.
19.
OsadaDFujitaSTamaiKYamaguchiTIwamotoASaotomeK. Flexor tendon repair in zone II with 6-strand techniques and early active mobilization. J Hand Surg Am. 2006, 31: 987–92.
20.
RiazMHillCKhanKSmallJO. Long term outcome of early active mobilization following flexor tendon repair in zone 2. J Hand Surg Br. 1999, 24: 157–60.
21.
SavageRRisitanoG. Flexor tendon repair using a “six strand” method of repair and early active mobilisation. J Hand Surg Br. 1989, 14: 396–9.
22.
SilfverskiöldKLMayEJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg Am. 1994, 19: 53–60.
23.
SilfverskiöldKLMayEJTörnvallAH. Flexor digitorum profundus tendon excursions during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg Am. 1992, 17: 122–31.
24.
SimmonsBPDeLaCaffinièreJY. Physiology of flexion of the fingers. In: TubianaR (Ed.) The hand. Philadelphia, WB Saunders, 1981, Vol. 1: 377–88.
25.
StricklandJWGlogovacSV. Digital function following flexor tendon repair in Zone II: A comparison of immobilization and controlled passive motion techniques. J Hand Surg Am. 1980, 5: 537–43.
26.
StricklandJWGettleKH. Flexor tendon repair: The Indianapolis method. In: HunterJMSchneiderLHMackinEJ (Eds.) Tendon and nerve surgery in the hand: a third decade. St. Louis, Mosby, 1997: 353–61.
27.
TangJB. Clinical outcomes associated with flexor tendon repair. Hand Clin. 2005, 21: 199–210.
28.
TangJB. Indications for primary flexor tendon repair. In: TangJBAmadioPCGuimberteauJCChangJ (Eds.) Tendon surgery of the hand. Philadelphia, Elsevier Saunders, 2012: 81–7.
TangJB. Outcomes and evaluation of flexor tendon repair. Hand Clin. 2013b, 29: 251–9.
31.
TangJBChangJElliotDLalondeDHSandowMVögelinE. IFSSH flexor tendon committee report 2014: from the IFSSH flexor tendon committee (chairman: Jin Bo Tang). J Hand Surg Eur. 2014, 39: 107–15.
32.
TangJBShiDGuYQChenJCZhouB. Double and multiple looped suture tendon repair. J Hand Surg Br. 1994, 19: 699–703.
33.
YoshizuT. Immediate mobilization following flexor tendon repair (in Japanese). J Musculoskelet Syst. 1996, 9: 881–90.
34.
ZhaoCAmadioPCZobitzMEAnKN. Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro. J Hand Surg Am. 2002, 27: 316–21.
