A Comparison of Post-Operative Mobilization of Flexor Tendon Repairs with “Passive Flexion–Active Extension” and “Controlled Active Motion” Techniques

Bainbridge, L. C.; Robertson, C.; Gillies, Donna; Elliot, David

doi:10.1016/0266-7681(94)90219-4

Cited by 118 publications

(73 citation statements)

References 14 publications

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“…As techniques in flexor tendon repair have advanced, the merits of early mobilization, reduction of bulk at the repair site, and minimization of gapping have been established [1][2][3][4][5][6][7][8]. Many different suture repair techniques exist, but all require the placement of one or more knots located within or external to the tendon repair site [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Analysis of Knotless Flexor Tendon Repair Using Large-Diameter Unidirection Barbed Suture

Lin

Lakhiani

Lee

et al. 2013

Hand (New York, N,Y.)

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Purpose In traditional flexor tendon repairs, suture knots can be sites of weakness, impair tendon healing, stimulate an inflammatory response, and increase the bulk of the tendon repair. Because of this, there has been an increased interest in knotless flexor tendon repair using barbed suture. Since knots are not required, it may be possible to increase the strength of the tendon repair by using a large-diameter barbed suture. The purpose of this study was to biomechanically compare a traditional four-strand tendon repair using 3-0 braided polyester with a similar knotless four-strand tendon repair using 0 unidirectional barbed suture. Methods Twenty-two matched cadaveric flexor digitorum profundus tendons were lacerated and assigned to repair by a four-strand modified Kirchmayr-Kessler technique using 3-0 braided polyester (n=11) or knotless four-strand modified Kirchmayr-Kessler repair using 0 unidirectional barbed suture (n=11). Repaired tendons were linearly distracted to failure at 20 mm/min after 1 N preload. Maximum load and load at 2-mm gap formation were recorded. Maximum load and load at 2-mm gap formation were compared with the Student's t test, and p values≤0.05 were considered significant. Results The mean maximum load of the barbed, knotless suture repair was higher than that of the traditional repair (52 vs. 42 N). There was no difference between the two groups in the mean load required to produce a 2-mm gap. Conclusions The four-strand knotless tendon repairs using a large-diameter unidirectional barbed suture were stronger than the traditional four-strand repairs using 3-0 braided polyester, and had similar 2-mm gap resistance.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Analysis of Knotless Flexor Tendon Repair Using Large-Diameter Unidirection Barbed Suture

Lin

Lakhiani

Lee

et al. 2013

Hand (New York, N,Y.)

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“…30,31 More recently, active motion protocols have been shown to improve clinical outcomes after flexor tendon repair. [32][33][34] In a level I prospective, randomized study, Trumble and colleagues 35 compared passive motion rehabilitation programs with early active motion with place-and-hold rehabilitation programs. Patients treated with early active range of motion when compared with passive program had greater interphalangeal joint motion, fewer flexion contractures, and greater satisfaction scores.…”

Section: Tendon Adhesionmentioning

confidence: 98%

Management of Complications of Flexor Tendon Injuries

Pulos

Bozentka

2015

Hand Clinics

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“…L'amélioration de la résistance à l'étirement et à la rupture des nouvelles techniques de suture en a fait une méthode populaire depuis quelques années [28][29][30][31]. Le poignet et la main sont maintenus dans le même type d'attelle que pour les méthodes précédentes, et le patient est encouragé dès le lendemain de l'intervention à fléchir de façon active douce ses articulations interphalangiennes plusieurs fois par jour.…”

Section: Rééducation Postopératoireunclassified

Plaies des tendons fléchisseurs des doigts: les techniques actuelles de réparation et de rééducation

Leclercq

2006

Lett Med Phys Readapt

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Les plaies des tendons fléchisseurs posent encore de difficiles problèmes thérapeutiques, principalement liés aux risques d'adhérences et de rupture tendineuse secondaire. Ces risques influent à la fois sur le choix de la technique de suture et sur la technique de rééducation.Les conceptions classiques de cicatrisation « extrinsèque » des tendons imposaient une immobilisation complète de quatre semaines après suture, ce qui augmentait la formation d'adhérences. Les tentatives de mobilisations précoces protégées, tel le procédé de Kleinert, se heurtaient à de nombreuses complications. Les conceptions plus modernes de cicatrisation « intrinsèque » des tendons ont permis de s'orienter vers une mobilisation précoce, mais avec un risque accru de rupture tendineuse.L'amélioration de nos connaissances en matière de biologie et d'anatomo-pathologie de la cicatrisation tendineuse a permis de concevoir de nouvelles techniques de suture, beaucoup plus résistantes que par le passé, autorisant donc une mobilisation quasi immédiate des tendons fléchisseurs. Ces nouvelles techniques devraient diminuer notablement le risque d'adhérences et le recours aux ténolyses secondaires.Abstract: Lacerations of flexor tendons remain a difficult challenge to the hand surgeon, mainly because of secondary adhesions or ruptures of the repaired tendons. These potential complications influence our choice of both technique of repair and postoperative rehabilitation.The classical concept of ''extrinsic healing'' of tendons made necessary to immobilise the sutured tendon for four weeks, which increased adhesions. Attempts at early protected motion, such as the Kleinert procedure, gave rise to a number of complications. Current concepts of ''intrinsic healing'' of flexor tendons have led to early protected motion, but with an increased risk of tendon rupture. A better understanding of physio-pathology of tendon healing has led to new techniques of tendon sutures, much stronger, thus allowing immediate postoperative motion. These techniques should markedly reduce the risk of adhesions and the need for secondary tenolyses.

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A Comparison of Post-Operative Mobilization of Flexor Tendon Repairs with “Passive Flexion–Active Extension” and “Controlled Active Motion” Techniques

Cited by 118 publications

References 14 publications

Biomechanical Analysis of Knotless Flexor Tendon Repair Using Large-Diameter Unidirection Barbed Suture

Biomechanical Analysis of Knotless Flexor Tendon Repair Using Large-Diameter Unidirection Barbed Suture

Management of Complications of Flexor Tendon Injuries

Plaies des tendons fléchisseurs des doigts: les techniques actuelles de réparation et de rééducation

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