gms | German Medical Science

Objective: Kleinert regimens have been popularized for postoperative treatment of flexor tendon injuries. A 6-strand suture procedure can tolerate early active mobilization (EAM) in a biomechanical study. Thus, EAM became popular, but resulted in re-rupture in approximately 5% of clinical cases. To reduce the incidence of re-rupture, we applied a novel treatment that combined an 8-strand cross-locked cruciate suture technique (Watanabe procedure) and EAM. We compared the outcomes of 6-strand suture with the modified Kleinert regimens and the novel treatment method.

Materials and Methods: We reviewed the outcome in 42 fingers of 36 patients with flexor tendon injuries in zones 1 and 2 who underwent treatment in our institution between 2008 and 2018. Group A included 13 fingers of 12 patients treated with the novel treatment and group B included 29 fingers of 24 patients treated with 6-strand suture with the modified Kleinert regimens. We determined the mean age, range of motion (ROM; i.e., the sum of the proximal and distal interphalangeal joint angles), outcome of the original Strickland criteria, and total therapy duration.

Results: No significant difference in mean age (29 vs 36 years) was found between groups A and B. According to the original Strickland criteria, the outcomes were excellent, good, and fair in 11, 1, and 1 finger in group A, and excellent, good, and poor in 22, 5, and 2 fingers in group B, respectively. No significant difference was found in ROM (156.6° in both groups). A significant difference was found in total therapy duration (group A vs group B: 90 vs 117 days). Moreover, no re-rupture occurred in both groups.

Conclusions: Our data demonstrate an equivalent ROM and no re-rupture in both groups. However, the therapy duration was shorter in group A than in group B by 27 days. In terms of the risk of re-rupture and therapy duration, our novel concept is beneficial for the treatment of flexor tendon injuries.