Early Active Mobilisation Following Flexor Tendon Repair in Zone 2

Small, J.O.; Brennen, M. D.; Colville, J.

doi:10.1016/0266-7681_89_90152-6

Cited by 82 publications

(13 citation statements)

References 44 publications

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“…In the postoperative period, having patients engage in active exercises, rather than passive exercises, is recommended to prevent adhesion. Since passive exercises are insufficient for tendon repair, early active exercises are initiated; additionally, tendon slipping is increased, adhesion is prevented by postoperative active exercise [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

The effect of increasing the contact surface on tendon healing

et al. 2018

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BackgroundThe most common complication after tendon repair is the development of adhesion, with subsequent rupture.MethodsIn this study, we present a new method in which the tendon healing contact surface is increased to reduce these complications. The tendons of chickens in groups 1, 3, and 5 were transversely cut and repaired with in the traditional fashion with double-modified Kessler method and 5/0 polypropylene. In the other groups, 3 mm of the tendon was removed from the proximal half of the upper end and from the distal half of the lower end of the tendon, and they were repaired with the modified Kessler method. The tendons of the chickens in groups 1 and 2 were evaluated immediatelly after surgery. Groups 3 and 4 were evaluated at 4 weeks after surgery. Groups 5 and 6 were evaluated at 6 weeks.ResultsIncreases in transient inflammation and connective tissue formation were observed more clearly in the group treated with the new method in histopathological investigations at weeks 4 and 6. The stretching test showed statistically significant differences between groups 3 and 4 (P<0.05) and groups 5 and 6 (P<0.05).ConclusionsWhen repairing tendons with the new method, the healing surface increases and the direction of collagen fibers at the surface changes. Because of these effects, the strength of the tendon healing line increases; we therefore expect that this technique will enable patients to safely engage in early active exercise after the operation, with less risk of tendon rupture.

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Section: Discussionmentioning

confidence: 99%

The effect of increasing the contact surface on tendon healing

et al. 2018

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“…On postoperative day 1, dynamic active exercises for the fingers were performed with a dorsal splint protecting the wrist and without the assistance of rubber bands. The rehabilitation process consisted of active extension and active flexion according to early active motion protocols [ 6 , 7 ]. The patients were strictly advised not to passively stretch the repaired tendons, not to remove the splint unless instructed, and avoid holding the hand in a dependent position.…”

Section: Methodsmentioning

confidence: 99%

Flexor Tenorrhaphy Using Absorbable Suture Materials

Kang

Lee

et al. 2012

Arch Plast Surg

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BackgroundNonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model.MethodsTwo-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies.ResultsAmong the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates.ConclusionsTherefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

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“…HA has been demonstrated as a highly biocompatible material as it does not evoke an immune response in vivo due to its ability to alter immune cell behavior . HA has several important roles during tendon healing and rehabilitation, including migration, proliferation, and differentiation of various cells, as well as adhesion prevention. − A commonly occurring postoperative complication, particularly debilitating in flexor tendon rehabilitation, is the formation of fibrotic adhesions between the tendon and surrounding tissues during repair. − These adhesions reduce tendon gliding capacity and, therefore, restrict range of motion in the affected body part . Tendons coated or soaked in HA and later subjected to biomechanical testing have demonstrated reduced gliding resistance and thus may act to limit adhesion formation. − HA can prevent the formation of these adhesions by inhibiting mononuclear phagocyte and lymphocyte activity .…”

Section: Gag-loaded Scaffoldsmentioning

confidence: 99%

Glycosaminoglycans in Tendon Physiology, Pathophysiology, and Therapy

Ryan¹,

Sorushanova²,

Lomas³

et al. 2015

Bioconjugate Chem.

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Although glycosaminoglycans constitute a minor portion of native tissues, they play a crucial role in various physiological processes, while their abnormal expression is associated with numerous pathophysiologies. Glycosaminoglycans have become increasingly prevalent in biomaterial design for tendon repair, given their low immunogenicity and their inherent capacity to stimulate the regenerative processes, while maintaining resident cell phenotype and function. Further, their incorporation into three-dimensional scaffold conformations significantly improves their mechanical properties, while reducing the formation of peritendinous adhesions. Herein, we discuss the role of glycosaminoglycans in tendon physiology and pathophysiology and the advancements achieved to date using glycosaminoglycan-functionalized scaffolds for tendon repair and regeneration. It is evidenced that glycosaminoglycan functionalization has led to many improvements in tendon tissue engineering and it is anticipated to play a pivotal role in future reparative therapies.

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Early Active Mobilisation Following Flexor Tendon Repair in Zone 2

Cited by 82 publications

References 44 publications

The effect of increasing the contact surface on tendon healing

The effect of increasing the contact surface on tendon healing

Flexor Tenorrhaphy Using Absorbable Suture Materials

Glycosaminoglycans in Tendon Physiology, Pathophysiology, and Therapy

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