Effectiveness of flexor tenolysis in zone II: A retrospective series of 40 patients at 3 months postoperatively

Breton, Armelle; Jäger, Thomas; Dap, F.; Dautel, G.

doi:10.1016/j.main.2015.04.002

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…Eggli et al 5 performed concurrent tenolysis and capsulolysis on 19 digits, with an average TAM improvement of 12° more than tenolysis without capsulolysis (55° vs 43°, respectively). Breton et al 4 reviewed 57 patients (70 fingers) and reported a mean increase in TAM of 60° following flexor tenolysis only, 32° for both flexor and extensor tenolysis, and 90° for flexor tenolysis with PIPJ capsulotomy after 6 weeks, although 7 patients had tendon rupture. Foucher et al completed flexor tenolysis on 78 digits, including 24 that underwent concurrent palmar arthrolysis.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] When active range of motion (AROM) remains significantly less than passive range of motion (PROM) despite at least 3 to 6 months of intensive hand therapy, surgical tenolysis of flexor tendon adhesions may be considered. [4][5][6] However, it has historically been advocated that a full PIPJ PROM should be achieved prior to flexor tenolysis. [7][8][9] If splinting and passive stretching exercises are inadequate to overcome joint contractures, surgical release of the joint capsule and associated structures may be necessary.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Secondary Combined Proximal Interphalangeal Joint Release and Zone II Flexor Tenolysis

Zuo

Saggaf

Schroeder

et al. 2019

Hand (New York, N,Y.)

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Background: Tendon adhesions and capsular contractures following trauma to the proximal interphalangeal joint (PIPJ) may significantly reduce hand function. Traditional, staged surgical management prioritizes restoration of PIPJ passive range of motion with joint release prior to restoration of active range of motion (AROM) with tenolysis. This is expensive and burdensome for patients. Our objective was to evaluate functional outcomes of combined PIPJ release and zone II flexor tenolysis. Methods: We retrospectively reviewed patients who underwent combined PIPJ release and flexor tenolysis. Replantation and tendon graft cases were excluded. Data were collected on pre- and postoperative AROM, total active motion (TAM), tip to distal palmar crease (DPC) distance, and grip strength. Functional outcomes were graded using the Boyes, American Society for Surgery of the Hand, and modified Strickland scores. Results: Twelve patients (9 men and 3 women, median age = 40 years) with a total of 15 digits underwent combined PIPJ release and flexor tenolysis a median of 10.1 months after injury. At a median follow-up of 4.0 months, there were significant improvements in median PIPJ AROM (15° to 70°), TAM (105° to 223°), tip to DPC distance (6.0 to 2.0 cm), and grip strength (35% to 54% of unaffected hand). Modified Strickland score was good in 46% of digits and excellent in 38%. There were no tendon ruptures, surgical site infections, or devascularized digits. Conclusion: Proximal interphalangeal joint stiffness is a challenging complication of hand trauma. Although a complete return to premorbid range of motion and function is rarely attained with surgery, improved outcomes may be consistently achieved with secondary combined PIPJ release and zone II flexor tenolysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Secondary Combined Proximal Interphalangeal Joint Release and Zone II Flexor Tenolysis

Zuo

Saggaf

Schroeder

et al. 2019

Hand (New York, N,Y.)

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“…Use of continuous passive motion following tenolysis does not provide significant gains in range of motion and 110e Plastic and Reconstructive Surgery • January 2022 was associated with increased number of therapy clinic visits (Level III Evidence). 36 Following tenolysis, more than 80 percent of patients will notice improvement, whereas 10 percent may have a worse outcome 22,[37][38][39] (Level IV Evidence). The overall rate of flexor tendon rupture following tenolysis ranges from 10 to 16 percent.…”

Section: Options For Limited Tendon Motion Tenolysismentioning

confidence: 99%

Secondary Procedures following Flexor Tendon Reconstruction

Gillis

Moran

2021

Plastic &Amp; Reconstructive Surgery

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he incidence of flexor tendon injury is 33 injuries per 100,000 person-years. 1,2 Advancements in flexor tendon repair, including wide-awake surgery, have led to improved outcomes. 3 In studies using multiple strand repairs and active range of motion, excellent results (defined as total active range of motion more than 150 degrees 4 ) have been noted in up to 86 percent of cases. 5,6 Despite this, reoperation still occurs. In a retrospective review of 5229 patients undergoing primary flexor tendon repair, there was a 6 percent reoperation rate, with 58 percent of these patients requiring tenolysis alone, 38 percent requiring rerepair alone, and 4 percent requiring both. 7 In such cases, the surgeon must have an understanding of the available reconstructive options for the treatment of patients with neglected, failed, or scarred tendon repairs. This article will review the indications and management options for failed flexor tendon surgery. THE MECHANICAL IMPACT OF FAILED FLEXOR TENDON REPAIRComplications following flexor tendon repairs include decreased range of motion, tendon bowstringing, quadriga, and lumbrical-plus deformity. 8-10 Compared to patients with primary flexor tendon repair, who have a mean QuickDASH score of 19.3, patients who require two-stage tendon reconstruction have a mean QuickDASH score of 34.4, emphasizing the importance of successful primary repair. 11 Flexor tendon pulley injury and tendon bowstringing can contribute to poor results. The pulley system consists of several fibro-osseous tunnels that run from the metacarpal head to the distal interphalangeal joint. These tunnels hold the tendons close to the joint's axis, allowing maximal motion for small amounts of tendon excursion. Biomechanical cadaver studies show an 8.5 percent increase in tendon excursion with loss of the A2 pulley, a 9.9 percent increase with loss of the A4 pulley, and a 33.7 percent increase with loss of both A2 and A4. 12 The loss of both pulleys leads to a 107 percent increase in the work of flexion. 12 This can lead to loss of motion and joint contracture. Pulley damage can be avoided by accessing and performing the tendon repair through the cruciate pulleys. Recent reports have shown that

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“…In flexor tendon surgery, clinicians believe that the early motion of the digits prevents the formation of adhesions with adequate physical therapy; however, the state and strength of the tendon after surgery may limit the application of such therapy [120]. Early motion eliminates adhesions by physical contact due to the gliding of the tendon [121], preventing the settlement of adhesions and production of more fibrotic tissue.…”

Section: Physical Therapymentioning

confidence: 99%

Battling adhesions: from understanding to prevention

et al. 2019

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Adhesions represent a major burden in clinical practice, particularly following abdominal, intrauterine, pericardial and tendon surgical procedures. Adhesions are initiated by a disruption in the epithelial or mesothelial layer of tissue, which leads to fibrin adhesion sites due to the downregulation of fibrinolytic activity and an increase in fibrin deposition. Hence, the metabolic events involved in tissue healing, coagulation, inflammation, fibrinolysis and angiogenesis play a pivotal role in adhesion formation. Understanding these events, their interactions and their influence on the development of post-surgical adhesion is crucial for the development of effective therapies to prevent them. Mechanical barriers, antiadhesive agents and combination thereof are customarily used in the battle against adhesions. Although these systems seem to be effective at reducing adhesions in clinical procedures, their prevention remains still elusive, imposing the need for new antiadhesive strategies.

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Effectiveness of flexor tenolysis in zone II: A retrospective series of 40 patients at 3 months postoperatively

Cited by 13 publications

References 30 publications

Outcomes of Secondary Combined Proximal Interphalangeal Joint Release and Zone II Flexor Tenolysis

Outcomes of Secondary Combined Proximal Interphalangeal Joint Release and Zone II Flexor Tenolysis

Secondary Procedures following Flexor Tendon Reconstruction

Battling adhesions: from understanding to prevention

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