Rehabilitation after surgery for flexor tendon injuries in the hand

Thien, Theun B; Becker, Jeroen H.; Theis, Jean‐Claude

doi:10.1002/14651858.cd003979.pub2

Cited by 55 publications

(29 citation statements)

References 29 publications

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“…In light of this body of research, Kim et al () suggested the following surgical techniques to improve upon historical methods: (1) 8‐core suture strands with a high‐caliber suture material, (2) a purchase length of ∼1.2 cm, (3) a locking‐loop configuration with the knot placed outside the repair site, and (4) a peripheral suture placed deep into the tendon and far away from the cut end. An equally extensive series of studies examining rehabilitation protocols for flexor tendon repairs also exists (Small et al, ; Thien et al, ; Chesney et al, ). Both early active motion protocols and regimens combining passive flexion with active extension result in low rates of tendon re‐rupture and good range of motion following repair.…”

Section: Current Clinical Treatments For Common Tendon Injuriesmentioning

confidence: 99%

Tendon and ligament regeneration and repair: Clinical relevance and developmental paradigm

Yang

Rothrauff

Tuan

2013

Birth Defects Research Pt C

379

305

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Tendon and ligament (T/L) are dense connective tissues connecting bone to muscle and bone to bone, respectively. Similar to other musculoskeletal tissues, T/L arise from the somitic mesoderm, but they are derived from a recently discovered somitic compartment, the syndetome. The adjacent sclerotome and myotome provide inductive signals to the interposing syndetome, thereby upregulating the expression of the transcription factor Scleraxis, which in turn leads to further tenogenic and ligamentogenic differentiation. These advances in the understanding of T/L development have been sought to provide a knowledge base for improving the healing of T/L injuries, a common clinical challenge due to the intrinsically poor natural healing response. Specifically, the three most common tendon injuries involve tearing of the rotator cuff of the shoulder, the flexor tendon of the hand, and the Achilles tendon. At present, injuries to these tissues are treated by surgical repair and/or conservative approaches, including biophysical modalities such as physical rehabilitation and cryotherapy. Unfortunately, the healing tissue forms fibrovascular scar and possesses inferior mechanical and biochemical properties as compared to native T/L. Therefore, tissue engineers have sought to improve upon the natural healing response by augmenting the injured tissue with cells, scaffolds, bioactive agents, and mechanical stimulation. These strategies show promise, both in vitro and in vivo, for improving T/L healing. However, several challenges remain in restoring full T/L function following injury, including uncertainties over the optimal combination of these biological agents as well how to best deliver tissue engineered elements to the injury site. A greater understanding of the molecular mechanisms involved in T/L development and natural healing, coupled with the capability of producing complex biomaterials to deliver multiple growth factors with high spatiotemporal resolution and specificity, will allow tissue engineers to more closely recapitulate T/L morphogenesis, thereby offering future patients the prospect of T/L regeneration, as opposed to simple tissue repair.

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Section: Current Clinical Treatments For Common Tendon Injuriesmentioning

confidence: 99%

Tendon and ligament regeneration and repair: Clinical relevance and developmental paradigm

Yang

Rothrauff

Tuan

2013

Birth Defects Research Pt C

379

305

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“…There is controversy regarding certain rehabilitation issues such as early/late mobilisation, position and type of the splint and mobilisation protocols (controlled passive motion, active extension/passive flexion or controlled active motion). There is still insufficient evidence to define the best mobilization strategy 44. Experimental studies suggest that motion enhances tendon repair especially the strength of repair by reducing oedema and preventing adhesions 45.…”

Section: Acute Flexor Tendon Injuriesmentioning

confidence: 99%

Zone 2 flexor tendon injuries: Venturing into the no man’s land

Kotwal

Ansari

2012

IJOO

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Flexor tendon injuries are seen commonly yet the management protocols are still widely debated. The advances in suture techniques, better understanding of the tendon morphology and its biomechanics have resulted in better outcomes. There has been a trend toward the active mobilization protocols with development of multistrand core suture techniques. Zone 2 injuries remain an enigma for the hand surgeons even today but the outcome results have definitely improved. Biomolecular modulation of tendon repair and tissue engineering are now the upcoming fields for future research. This review article focuses on the current concepts in the management of flexor tendon injuries in zone 2.

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“…All these studies except one (Peck et al, 1998) suggest better results with the EAM protocol. However, the clinical evidence supporting superiority of EAM in contrast to CPM is insufficient; not even systematic reviews could conclude what was the best rehabilitation protocol (Thien et al, 2004, Chesney et al, 2011.…”

Section: Rehabilitationmentioning

confidence: 99%

Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

Rigó

Haugstvedt

Ludvigsen

et al. 2012

Journal of Plastic Surgery and Hand Surgery

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There is a need for a strong suture technique that allows early active mobilisation after repair of flexor tendons, but the best method has not yet been found. The aim of this study was to compare the modified Kessler suture biomechanically with a newer, two-strand suture. Eighteen porcine tendons were cut and repaired according to either the grasping modified Kessler suture or the combined side-locking loop technique (Yotsumoto) and interlocking horizontal mattress suture (Dona). The specimens were tested linearly to failure. The 2 mm gap force, yield force, ultimate force, stiffness, energy to yield, and energy to failure were all significantly higher (p value = 0.005, 0.003, <0.001, 0.001, 0.004, and 0.001, respectively) in the Yotsumoto-Dona group (median values (IQR): 30.9 (28.1-39.5) N, 82.7 (64.9-114.1) N, 82.7 (76.6-114.1) N, 12.5 (10-14.5) N/mm, 0.45 (0.2-0.5) J, and 0.45 (0.35-0.5) J) than in the modified Kessler group (25.8 (12.2-28.1) N, 35 (24.6-54.4) N, 50.9 (34.4-55.1) N, 7 (5.8-91) N/mm, 0.09 (0.06-0.18) J, and 0.21 (0.18-0.28) J). All Yotsumoto-Dona specimens had a yield force exceeding 35 N, while in the Kessler group only four did. The early yielding rate was 6/9 and 2/9 in the modified Kessler and the Yotsumoto-Dona groups, respectively (p = 0.15). Most of the core sutures failed by breakage, but three Yotsumoto knots loosened. All the simple running and six of the Dona epitendinous sutures failed predominantly by pulling-out, and by breakage at the intersections in three of the latter. The relatively easy two-strand Yotsumoto-Dona suture is likely to withstand the loads of active finger flexion, whereas the modified Kessler suture is probably not.

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Rehabilitation after surgery for flexor tendon injuries in the hand

Abstract: Controlled mobilisation regimens are widely employed in rehabilitation after flexor tendon repair in the hand. This review found insufficient evidence from randomised controlled trials to define the best mobilisation strategy.

Cited by 55 publications

References 29 publications

Tendon and ligament regeneration and repair: Clinical relevance and developmental paradigm

Tendon and ligament regeneration and repair: Clinical relevance and developmental paradigm

Zone 2 flexor tendon injuries: Venturing into the no man’s land

Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

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