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Introduction: The aim of this study was to analyze primary flexor tendon repair results in zones I and II, comparing the rupture rate and clinical outcomes of the controlled active motion (CAM) protocol with the modified Kleinert/Duran (mKD) protocol. Materials and methods: Patients who underwent surgery with traumatic flexor tendon lacerations in zones I and II were divided in three groups according to the type of rehabilitation protocol and period of management: group 1 included patients who underwent CAM rehabilitation protocol with six-strand Lim and Tsai suture after May 2014. Group 2 and 3 included patients treated by six-strand Lim Tsai suture followed by a modified Kleinert/Duran (modK/D) protocol with additional place and hold exercises between 2003 and 2005 (group 2) and between 2011 and 2013 (group 3). Results: Rupture rate was 4.7% at 12 weeks in group 1 (3/63 flexor tendon repairs) compared to 2% (1/51 flexor tendon repairs) in group 2 and 8% in group 3 (7/86 flexor tendon repairs). The grip strength at 12 weeks was significantly better in group 2 compared to the group 1 (35 kg/25 kg, p = 0.006). The TAM in group 1 [113° (30–175°)] was significantly worse (p < 0.001) than the TAM in group 2 [141° (90–195°)] but with similar extension deficits in both groups. The assessment of range of motion by the original Strickland classification system resulted in 20% excellent and 15% good outcomes in the CAM group 1 compared with 42% and 36% in the modK/D group 2. Subanalysis demonstrated improvement of good/excellent results according to Strickland from 45% at 3 months to 63.6% after 6-month follow-up in the CAM group. Conclusion: The gut feeling that lead to change in our rehabilitation protocol could be explained by the heterogenous bias. A precise outcome analysis of group 1 could underline that in patients with complex hand trauma, nerve reconstruction, oedema or early extension deficit, an even more intensive and individual rehabilitation has to be performed to achieve better TAM at 6 or 12 weeks. Our study explicitly demonstrated a significant better outcome in the modK/D group compared to CAM group. This monocenter study is limited by its retrospective nature and the low number of patients. [ABSTRACT FROM AUTHOR]

Introduction. No single optimal regimen for the rehabilitation of flexor tendon injuries has yet been determined. We aimed to evaluate if a change in rehabilitation from a modified Kleinert to a controlled active motion (CAM) regimen had an effect on outcomes in a regional plastic surgery unit.We did this by comparing ruptures and range of movement of zone 2 repairs following both Kleinert and CAM regimens. Methods. We performed a retrospective case series review, analysing data collected prospectively between 2004 and 2007. During 2004 and 2005, patients were rehabilitated with a modified Kleinert regimen, and during 2006 and 2007 a CAM regimen was used. We looked at total active motion (TAM) and ruptures at 12- week follow-up for all zone 2 repairs, and compared the two regimens. Results. There were 38 patients with 42 injured digits in the Kleinert group, and 34 patients with 39 injured digits in the CAM group. There was no statistically significant difference in TAM achieved between the Kleinert and CAM regimens overall (70% versus 72% of normal in each group respectively, P = 0.70 t-test). Patients over 30 years old achieved significantly worse outcomes in the Kleinert group than in the CAM group (P = 0.03). One digit ruptured following a Kleinert regimen (2.6%) compared with four digits in the CAM group (11.7%). Conclusion. In this study, we found no overall difference in outcome following a Kleinert or CAM rehabilitation regimen. Rupture rates were higher in the CAM group by four-fold. In our patients those over 30 years had poorer outcomes when rehabilitated with a Kleinert regimen. [ABSTRACT FROM AUTHOR]

Objective: There has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated., Methods: 128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair., Results: Excellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20°., Conclusion: The low rupture rate (2.3%) and 91.4% 'good' and 'excellent' scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available., Level of Evidence: Level IV, therapeutic study., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)