Instructional lecture
Recent progress in flexor tendon healingAcknowledgments

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Abstract

Although advances in the treatment of flexor tendon injuries have led to improved clinical outcomes during the past several decades, a subset of patients continue to experience a loss of function. Using a canine model of sharp transection of the flexor digitorum profundus tendon followed by repair and rehabilitation using clinically relevant techniques, we have examined the influence of multistrand suture and postoperative rehabilitation variables on digital function and tendon strength. Our findings highlight the critical role of repair technique in providing a stiff and strong repair and indicate that continued refinement of suture techniques is warranted in order to minimize repair-site elongation (gap). Gap formation continues to occur at a high frequency, and the formation of gaps greater than 3 mm delays the accrual of repair-site strength that occurs with time. Furthermore, our results indicate that passive-motion rehabilitation that produces a moderate amount of tendon excursion (2mm) at low levels of tendon force (5 N) is sufficient to inhibit adhesion formation and to promote healing. Increases in excursion or force beyond these levels do not accelerate the healing process. These findings suggest that we are approaching the limit of the extent to which we can modulate healing by manipulating rehabilitation variables such as tendon excursion and force. Future advances will probably require manipulation ofthe biological factors that promote healing.

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Cited by (51)

  • Effect of wrist and interphalangeal thumb movement on zone T2 flexor pollicis longus tendon tension in a human cadaver model

    2015, Journal of Hand Therapy
    Citation Excerpt :

    The lower SEZ limit represents the viscoelastic drag of the repaired tendon within its sheath,27–29 while the upper SEZ limit represents the force a repair can withstand before gapping.30 Using a modified Kessler suture technique, the SEZ for the FPL was reported to be between 1.3 N31,32 and 7 N.22,26 Additionally, it has been suggested that a minimum of 2 mm of tendon excursion at the repair site is needed to minimize adhesions and thus maintain adequate tendon glide for functional motion.33–35 In this cadaveric study, we measured the forces acting on the FPL in zone T2 as induced by the tenodesis effect of wrist position while passively moving the isolated IP joint and passively performing a synergistic arc of wrist motion.

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Acknowledgments

The authors thank their many colleagues who contributed to these studies: David Amiel, Michael Brodt, Meghan Burns, Harry Dinopoulos, Konstantinos Ditsios, Rosemarie Hofem, Rick Lieber, Tim Morris, and Steve Winters. Funding was provided by the U.S. National Institutes of Health (AR33097, NIAMS).

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