Abstract
Dear Editor,
Re: Renberg M, Turesson C, Borén L, Nyman E, Farnebo S. Rehabilitation following flexor tendon injury in Zone 2: a randomized controlled study. J Hand Surg Eur. 2023, 48: 783–91. doi: 10.1177/17531934231166336
We read this report of a level I study with interest. We noted that the early active motion protocol used in this study involved only four exercise sessions each day and in each session five runs of passive motion were implemented followed by active flexion. The specific number of runs of active motion is not given in the text. We are unsure if there are only five active runs or slightly more than five (for example, 10 runs) in each exercise session. The active flexion protocol used has an insufficient number of runs, which is the earliest version of active motion published 34 years ago (Cullen et al., 1989). There have been a number of updated versions of early active motion over the past 30 years, with either an increased number of exercise sessions or more runs in each session (Tang, 2021; Tang et al., 2017) and the earliest regime is no longer commonly used.
In addition, the good and excellent rate of the digits in both groups in this study was at approximately 60% with the Strickland criteria, which is considered a very unsatisfactory outcome nowadays. Over the past two decades, a good and excellent rate has been commonly reported to be at approximately 80% or above.
Therefore, it is reasonable that the results of this study may also lead to the following conclusion: both regimes do not lead to optimal outcomes of flexor tendon repairs and early active flexion exercise without sufficient runs each day lead to outcomes similar to a Kleinert protocol. We caution readers to interpret the findings of this study with care.