Outcomes and Evaluation of Flexor Tendon Repair

Flexor tendon, Primary repair, Secondary repair, Outcomes, Assessment criteria, Level of expertise of the surgeons

• Most reports document a good or excellent recovery of the function of the repaired digits of more than about 80% from fine hand units over recent years, but outcomes in general hospital settings can be more disappointing.
• Over recent years, although rupture of the primarily repaired flexor tendons is still seen in the reports, a few have reported not having ruptures after strong surgical repair, judicious venting of the pulley, and early active postoperative tendon motion.
• The Strickland criteria remain the most commonly used to record the outcomes.
• The author proposes modifying the assessment criteria by setting more stringent “excellent” results as recovery to or greater than 90% of the normal finger motion range and by adding “failure” to designate those digits of recovery of active range of motion less than 30%.
• The outcomes should be provided by subzones of the tendon injuries, and the level of expertise of the surgeons is reported to allow comparisons of the results.

• Most published papers, rupture rate after repair, reop rate, adhesions < 10%
• General results not as good (JB Tang 2013). Why? less experienced/non-master surgeons, publication bias, set up etc.; little fingers particularly difficult

• Adds a clinical test intra-op to determine if repair is adequate

1. Strickland (1980)
   1. most popular
   2. Excellent (85-100% > 150°); Good (70-84 125-149°); Fair (50-69 90-124), Poor (0-49 <90)
2. Buck-Gramcko
3. TAM

As Teemu points out, flexor tendon scoring systems turn a quantitative measure (AROM) into a qualitative one. There is lack of consensus for what is excellent: this paper suggests the original Strickland and Strickland-Glogovac is too lenient, and raises the bar for excellence (90% TAM, and adding a “failure” category < 30%).

Tang also discusses the expertise of the person doing the surgery, as well as reporting of injury by subzones.

• Teemu's paper
• Flexor tendon healing
• Hardwicke, J. T., Tan, J. J., Foster, M. A., & Titley, O. G. (2014). A Systematic Review of 2-Strand Versus Multistrand Core Suture Techniques and Functional Outcome After Digital Flexor Tendon Repair. The Journal of Hand Surgery, 39(4), 686-695.e2. https://doi.org/10.1016/j.jhsa.2013.12.037
• Tang, J. B. (2005). Clinical Outcomes Associated with Flexor Tendon Repair. Hand Clinics, 21(2), 199–210. https://doi.org/10.1016/j.hcl.2004.11.005
• Tang, J. B. (2013). Outcomes and Evaluation of Flexor Tendon Repair. Hand Clinics, 29(2), 251–259. https://doi.org/10.1016/j.hcl.2013.02.007

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