COMPARISON OF OUTCOME OF 1- AND 2-KNOT, 4-STRAND, DOUBLE-MODIFIED KESSLER FLEXOR TENDON REPAIR WITH EARLY ACTIVE MOBILIZATION PROTOCOL IN PATIENTS WITH FLEXOR TENDON LACERATIONS OF HAND
Abstract
Background: Hand is unique for the dexterity of its function and flexor tendons have most important function in hand. Its injury is a challenging treatment. Purpose of this study is to compare the success of 1- and 2-knot, flexor tendon repair (good to excellent results) with early active mobilization in terms of total active motion (TAM) of affected hand postoperatively. Methods: Hundred patients with age range of 5-70 years of age presenting with flexor tendon lacerations of hand were included in the study. Subjects were randomly divided into Group A, who underwent flexor tendon repair using 4 strands of double modified Kessler repair with 1 knot and Group B, in which 4 strand double modified Kessler repair with 2 knot technique was used. All patients followed early active motion protocol started in first 48 hours. They were followed at 3, 6 and 8 weeks after surgery for TAM. Data was entered and analysed in SPSS ver: 21.0. Frequency and percentages were calculated for outcome of procedure. Results: In group A 89.8% (44) of patients had good to excellent results in terms of total active motion (TAM) as compared with 90.9% (40) in group B using early active mobilization protocol. Conclusion: The study concluded that that four strand double modified flexor tendon repair using either 1 or 2 knot technique are excellent choices of repair with early active mobilization protocols.
Keywords: Flexor tendon injuries; 4 strand repair; Total active motion; Early active mobilizationReferences
Ahmad M, Hussain SS, Tariq F, Rafiq Z, Khan MI, Malik SA. Flexor tendon injuries of hand: experience at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. J Ayub Med Coll Abbottabad 2007;19(1):6-9.
Trumble TE, Vedder NB, Seiler JG 3rd, Hanel DP, Diao E, Pettrone S. Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy. J Bone Joint Surg Am 2010;92(6):1381-9.
Saini N, Kundnani V, Patni P, Gupta S. Outcome of early active mobilization after flexor tendons repair in zones II-V in hand. Indian J Orthop 2010;44(3):314-21.
Kitis PT, Buker N, Kara IG. Comparison of two methods of controlled mobilisation of repaired flexor tendons in zone 2. Scand J Plast Reconstr Surg Hand Surg 2009;43(3):160-5.
Rees L, Matthews A, Masouros SD, Bull AM, Haywood R. Comparison of 1- and 2-knot, 4-strand, double-modified kessler tendon repairs in a porcine model. J Hand Surg Am 2009;34(4):705-9.
Wada A, Kubota H, Miyanishi K, Hatanaka H, Miura H, Iwamoto Y. Comparison of postoperative early active mobilization and immobilization in vivo utilizing a four-strand flexor tendon repair. J Hand Surg Br 2001;26(4):301-6.
Karlander LE, Berggren M, Larsson M, Soderberg G, Nylander G. Improved results in zone 2 flexor tendon injuries with a modified technique of immediate controlled mobilization. J Hand Surg Br 1993;18(1):26-30.
Buck-Gramcko D, Dietrich FE, Gogge S. Evaluation criteria in follow-up studies of flexor tendon therapy. Handchirurgie 1976;8(2):65-9.
Cullen KW, Tolhurst P, Lang D, Page RE. Flexor tendon repair in zone II followed by controlled active mobilization. J Hand Surg Br 1989;14(4):392-5.
Chow SP, Stephens MM, Ngai WK, So YC, Pun WK, Chu M, et al. A splint for controlled active motion after flexor tendon repair: Design, mechanical testing, and preliminary clinical results. J Hand Surg Am 1990;15(4):645-51.
Silfverskiold KL, May EJ, Tornvall AH. Tendon excursion after flexor tendon repair in zone II: Result with a new controlled motion program. J Hand Surg Am 1993;18(3):403-10.
Silfverskiold KL, May EJ, Tornvall AH. Flexor digitorum profundus tendon excursions during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg Am 1992;17(1):122-31.
Hung LK, Pang KW, Yeung PL, Cheung L, Wong JM, Chan P. Active mobilisation after flexor tendon repair: comparison of results following injuries in zone 2 and other zones. J Orthop Surg (Hong Kong) 2005:13(2):158-63.
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