gms | German Medical Science

Objectives/Interrogation:

1.

To review the functional outcomes of surgical (tenolysis, arthrolysis and teno-arthrolysis) and non-surgical (mobilisation and splinting) interventions that are used to treat the stiff proximal interphalangeal joint (PIPJ) following flexor tendon surgery.

2.

To evaluate the complication rates of each of these surgical and non-surgical interventions.

Methods: A PRISMA compliant search of databases registering published and unpublished literature prior to May 2018 was conducted. This included Cochrane, Medline, Embase, CINAHL, BioMed Central, Zetoc and PEDro. All studies that evaluated the change in function of the PIPJ following flexor tendon surgery were included. Animal and cadaveric studies were excluded. Methodological quality was assessed using the Downs & Black Protocol.

Results and Conclusions: A total of 1102 studies were identified in the preliminary search. Twelve studies assessing 685 digits met the inclusion and exclusion criteria. The mean age of participants was 35 (5-79) years old. While initial flexor tendon injury was the primary aetiology of PIPJ stiffness in all studies (accounting for 42.5% of all analysed digits), other aetiologies of PIPJ stiffness were included in the analysis of 11 studies. All interventions lead to an overall improvement in active and passive PIPJ motion. Surgical interventions led to a greater improvement in passive motion of the PIPJ compared to splinting (26º vs 18º), with teno-arthrolysis yielding the greatest gain in active and passive motion of the PIPJ. Of the studies reporting post-surgical complications, tenolysis yielded a higher rupture rate (7.78% N=249 vs 0% N=50; p=0.21) and infection rate (2.5% N=152 vs 0% N=50; p=0.42) compared to teno-arthrolysis. Skin dehiscence or necrosis was reported more frequently following teno-arthrolysis compared to tenolysis (6.25% N=67 vs 3.55% N=123; p=0.72). No cases of pulley rupture were noted in either group. There was significant heterogeneity in terms of surgical approach, mean follow-up (6-406 weeks) and timing of the intervention after initial injury (13-234 weeks). Furthermore, 83% of studies were considered to be of poor quality.

Whilst teno-arthrolysis appears superior to other surgical interventions or splinting, further high-quality research is warranted to identify and compare the true value of surgical and non-surgical interventions for managing the stiff PIPJ.