Management of Complications of Flexor Tendon Injuries

Pulos, Nicholas; Bozentka, David J.

doi:10.1016/j.hcl.2014.12.004

Cited by 14 publications

(18 citation statements)

References 58 publications

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“…Later complications include tendon adhesions, rupture of the repair site, joint contractures, quadriga, lumbrical plus deformity, and bowstringing. 1,34,35 In our clinical experience, complications in flexor tendon rehabilitation are likely to arise in different stages of the postoperative management, which is divided into three categories based on the stages of healing and tensile strength 35,38 1) orthotic intervention phase (4-6 weeks), 2) active phase (6-8 weeks), and 3) strengthening phase (8-12 weeks).…”

Section: Zone II Flexor Tendon Injuries: Anatomy and Common Complicatmentioning

confidence: 99%

“…Furthermore, certain tendon orthotic intervention techniques, particularly those involving dynamic traction into flexion, are prone to producing flexion contractures at the PIP joint. 9,34 By preventing the development of a PIP joint flexion contracture during phase 1 of tendon rehabilitation, formation of these late secondary complications can be minimized. Pettengill & Van Strein 8,9 outlined various methods proposed by several authors Fig.…”

Section: Proximal Interphalangeal Joint Flexion Contracturesmentioning

confidence: 99%

“…In these cases, patients may co-contract their lumbricals and interossei excessively as they attempt to make a fist, commonly observed in repaired tendons that have been immobilized or delayed in engaging in mobilization protocols. 9,34 As the flexor tendon reaches its limit of available excursion, the intrinsics continue to contract resulting in MCP joint hyperflexion and IP joint extension, or "lumbrical plus" phenomenon (►Fig. 12).…”

Section: Proximal Interphalangeal Joint Flexion Contracturesmentioning

confidence: 99%

“…Primary pathology of adhesions or joint contractures may slowly progress, altering flexor, extensor, and intrinsic tendon vectors leading to a kinematic chain imbalance and the development of secondary complications. 1,[32][33][34][35] Although tendon adhesions may be accompanied by other postoperative complications, such as gap formation and rupture, this paper will focus on reviewing relevant literature to understand the pathomechanics associated with tendon adhesions and reduced gliding amplitude in zone II. Kinematic imbalance and decreased function associated with tendon adhesions in zone II were also investigated by means of cadaver dissections and suturing of the tendons to simulate and comprehend the effect of tendon adhesions at different levels based on the orientation of the flexor digitorum profundus (FDP)/flexor digitorum superficialis (FDS).…”

Section: Introductionmentioning

confidence: 99%

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Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

2016

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Despite the number of rehabilitation strategies and guidelines developed to maximize the gliding amplitude of repaired tendons, secondary complications, such as decreased range of motion and stiffness associated with tendon adhesions, commonly arise. If left untreated, these early complications may lead to secondary pathomechanical changes resulting in fixed deformities and decreased function. Therefore, an appropriate treatment regimen must not only include strategies to maintain the integrity of the repaired tendon, but must also avoid secondary complications due to reduced gliding amplitude. This review presents a biomechanical analysis of the dynamics of tendon gliding following repair in zone II and rehabilitation strategies to minimize secondary complications related with tendon adhesions.

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Section: Zone II Flexor Tendon Injuries: Anatomy and Common Complicatmentioning

confidence: 99%

Section: Proximal Interphalangeal Joint Flexion Contracturesmentioning

confidence: 99%

Section: Proximal Interphalangeal Joint Flexion Contracturesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

2016

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“…In spite of improvements in surgical technique and postoperative mobilization, postoperative tendon adhesion still presents a major clinical problem in hand surgery. 2 During tendon healing, a combination of intrinsic and extrinsic processes occurs simultaneously. Intrinsic healing occurs within the tendon as a result of the activity of tenocytes and appropriate nutrition available to them.…”

Section: Introductionmentioning

confidence: 99%

Controlled release of curcumin from curcumin-loaded nanomicelles to prevent peritendinous adhesion during Achilles tendon healing in rats

Zhang¹,

Li²,

Franchini³

et al. 2016

IJN

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We introduced curcumin-loaded nanomicelles into a tendon-healing model to evaluate their effects on tendon healing and adhesion. Three groups consisting of 36 rats underwent rupture and repair of the Achilles tendon. The treatment group received an injection of curcumin-loaded nanomicelles (gold nanorods [GNRs]-1/curcumin in polymeric nanomicelles [curc@PMs] at a dosage of 0.44 mg curcumin/kg in 0.1 mL saline) into the surgical site and exposed to laser postoperatively at weeks 1, 2, and 3, for three times 10 seconds each, on the surgical site in the rats that underwent tendon rupture and repair, while the other two groups received 0.44 mg curcumin/kg in 0.1 mL saline and 0.1 mL of saline, respectively. The specimens were harvested at 4 weeks and subjected to biomechanical and histological evaluation. The scoring results of tendon adhesion indicated that GNRs-1/curc@PMs group was in the lowest grade of peritendinous adhesions compared to the other groups. Histological assessment further confirmed the preventive effect of GNRs-1/curc@PMs on tendon adhesion. These findings indicated greater tendon strength with less adhesion in the group treated with GNRs-1/curc@PMs combined with laser exposure, and that nanoparticle-based therapy may be applied to prevent adhesion in clinical patients.

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MMP‐2 Responsive Unidirectional Hydrogel‐Electrospun Patch Loading TGF‐β1 siRNA Polyplexes for Peritendinous Anti‐Adhesion

Cai

Wang

Liang

et al. 2020

Adv Funct Materials

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Bio‐derived hydrogel patch systems exhibit promising potential in localized drug delivery for the prevention and treatment of various diseases. However, the uncontrolled release from the hydrogel patch both in time and space, is not an optimal strategy for peritendinous anti‐adhesion, leading to transient effect and unnecessary diffusion of therapeutics. Here, an innovative composite anti‐adhesion patch is designed for on‐demand and unidirectional polyplexes delivery to inhibit fibroblasts proliferation and collagen deposition by silencing fibrosis gene transforming growth factor‐β1 (TGF‐β1). Firstly, a metalloproteinase‐2 (MMP‐2) degradable hydrogel is prepared by crosslinking allyl glycidyl ether (AGE) modified carboxymethyl chitosan (CMCS‐AGE) with MMP‐2 substrate peptide CPLGLAGC (MMP‐2 sp). Then, the hydrogel loading TGF‐β1 siRNA polyplexes are attached onto polycaprolactone (PCL) electrospun fibers to form a composite bilayer patch. The hydrogel–electrospun fibers (H–E) patch shows MMP‐2‐responsive and unidirectional release behaviors of encapsulated TGF‐β1 siRNA polyplexes and associated gene silencing effect on TGF‐β1, leading to the inhibition of fibroblasts proliferation. Moreover, after implanting the H–E patch by wrapping the repaired tendon, the formation of adhesion tissue is responsively attenuated in MMP‐2 overexpression microenvironment. This study presents a promising approach employing a composite bilayer patch with on‐demand and unidirectional delivery strategy for peritendinous anti‐adhesion.

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Management of Complications of Flexor Tendon Injuries

Cited by 14 publications

References 58 publications

Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

Controlled release of curcumin from curcumin-loaded nanomicelles to prevent peritendinous adhesion during Achilles tendon healing in rats

MMP‐2 Responsive Unidirectional Hydrogel‐Electrospun Patch Loading TGF‐β1 siRNA Polyplexes for Peritendinous Anti‐Adhesion

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