Comparative study between early active and passive rehabilitation protocols following two-strand flexor tendon repair: can two-strand flexor tendon repair withstands early active rehabilitation?

Abstract

Background Restoration of full range of motion of digits as well as prevention of joint contracture following flexor tendon repair is a challenge. There is lack of solid evidence regarding the most suitable rehabilitation protocol following flexor tendon repair. This is owing to the limited number of studies comparing different rehabilitation protocols. Moreover, the present studies advocate a specific technique with no comparative group. Even the few controlled studies conducted vary in methods of repair and rehabilitation, and outcome assessment. To our knowledge, the only randomized controlled trial comparing early passive rehabilitation with early active rehabilitation is the one done by Trumble and colleagues in 2010, which was done on four-strand repaired tendon. These authors concluded that active rehabilitation program had better range of motion with less flexion contractures and greater satisfaction scores than those subjected to passive rehabilitation protocol. Aim This conclusion stimulated us to study the effect of early active mobilization versus early passive mobilization following two-strand repair. Patient and methods We conducted our study for 12 weeks comparing early active mobilization protocol ‘place and hold’ with early passive mobilization ‘modified Kleinert’ after standard two-strand modified Kessler repair in different hand zones. Results and conclusion We concluded that early active mobilization had better tendon gliding and excursion even with the two-strand repair as active motion will decrease adhesion formation, with significant difference compared with the passive group. Moreover, there was no significant difference in the rupture rate and significant difference for combined tendon lag and flexion deformity owing to the tenodesis mobilization between both the groups.

Keywords

• flexion deformity
• flexor tendon repair
• rehabilitation
• tendon lag
• two-strand suture
• modified Kleinert