Negative Predictors of Outcomes of Flexor Tendon Repairs

Abstract

The current trend in hand surgery has streamlined the treatment of acute hand trauma to the modern-day surgery unit. As the volume of hand trauma caseloads continues to increase, it is becoming increasingly difficult to schedule patients for theater on the day of injury. It, therefore, becomes paramount to adequately triage patients in accordance with best clinical evidence and predictors of poor clinical outcomes. Animal models suggest that the earlier flexor tendons are repaired, the better the patient functional outcome. The largest study to date examining the timing of injury to functional post-operative outcome also recognizes that the faster these injuries are repaired, the better the patient outcome. Age-related changes to tendon biomechanics and structure are well-documented. However, no conclusive evidence exists specific to the degenerative changes and mechanical properties of flexor tendons in humans. The animal model strongly suggests that increasing age is associated with local architectural and biological changes that directly affect the tendon repair functional outcome. Although retrospective analyses to date suggest that smoking is a negative outcome predictor for functional tendon outcome, no prospective large-scale studies exist. A large, single-center prospective study specifically examining the positive and negative outcome predictors of flexor tendon repairs and functional post-operative outcome is warranted. The negative predictive model of patient care may enable us to further council patients preoperatively and stratify patients according to clinical need.

Risk factors for reoperation after flexor tendon repair: a registry study

“…As previous research suggests, we also found that patient age affected the risk of tendon rupture (Dy et al., 2012a; Hurley et al., 2019). An animal study on mice showed impaired tendon healing with increased age, explained by a dramatically less bridging tendon collagen at the repair site with increasing age (Ackerman et al., 2017).…”

“…High tenolysis rates in injuries to both tendons have previously been reported (Civan et al., 2020). Zone 2 injuries have been associated with a lower range of motion (Rigo and Røkkum, 2016) and are well established as the most difficult area of suture, although there are a lack of studies comparing different zones (Elliot and Giesen, 2013; Hurley et al., 2019).…”

Factors predicting reoperation after hand flexor tendon repair

“…[2,7] This is related to the difficult anatomy of this zone, which includes the FDS and FDP within its narrow fibro-osseous sheath. [26] Therefore, our finding that zone 2 injury was associated with complications and reoperation compared with other zones was expected.…”

A novel engineered purified exosome product patch for tendon healing: An explant in an ex vivo model

“…For tendon repair, previous studies have mainly focused on surgical techniques, growth factors, cell therapy, and tissue engineering scaffolds 27–29 . Despite new biological scaffolds and other treatments designed to improve tendon healing and minimize scar formation, the mechanical properties and proliferation of tenocytes remain problematic 30,31 . In this study, we proposed a novel engineered PEP patch for tendon healing, our results suggested that the Tisseel could improve biomechanics properties and the PEP could accelerate fibroblasts migrating to the injury site of tendon gap and reduce the inflammatory microenvironment in the injured site.…”