Abstract
Purpose: To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion. Methods: We searched PubMed and Cochrane Library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. All zones of injury were included. Articles were classified based on the protocol used during early rehabilitation. We analyzed clinical outcomes, focusing on incidence of tendon rupture and postoperative functional range of motion. We also analyzed the chronological incidence of published tendon rupture with respect to the protocol used. Results: We identified 170 articles, and 34 met our criteria, with evidence ranging from level I to level IV. Early passive motion, including both Duran and Kleinert type protocols, results included 57 ruptures (4%) and 149 fingers (9%) with decreased range of motion of 1598 tendon repairs. Early active motion results included 75 ruptures (5%) and 80 fingers (6%) with decreased range of motion of 1412 tendon repairs. Early passive range of motion protocols had a statistically significantly decreased risk for tendon rupture but an increased risk for postoperative decreased range of motion compared to early active motion protocols. When analyzing published articles chronologically, we found a statistically significant trend that overall (passive and active rehabilitation) rupture rates have decreased over time. Conclusions: Analyzing all flexor tendon zones and literature of all levels of evidence, our data show a higher risk of complication involving decreased postoperative digit range of motion in the passive protocols and a higher risk of rupture in early active motion protocols. However, modern improvements in surgical technique, materials, and rehabilitation may now allow for early active motion rehabilitation that can provide better postoperative motion while maintaining low rupture rates. Type of study/level of evidence: Therapeutic IV.
| Original language | English (US) |
|---|---|
| Journal | Journal of Hand Surgery |
| Volume | 38 |
| Issue number | 9 |
| DOIs | |
| State | Published - Jan 1 2013 |
| Externally published | Yes |
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Keywords
- Early active motion
- flexor tendon repair
- postoperative care
- rehabilitation
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
Cite this
Flexor tendon repair rehabilitation protocols : A systematic review. / Starr, Harlan M.; Snoddy, Mark Christopher; Hammond, Kyle E.; Seiler, John G.
In: Journal of Hand Surgery, Vol. 38, No. 9, 01.01.2013.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Flexor tendon repair rehabilitation protocols
T2 - A systematic review
AU - Starr, Harlan M.
AU - Snoddy, Mark Christopher
AU - Hammond, Kyle E.
AU - Seiler, John G.
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Purpose: To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion. Methods: We searched PubMed and Cochrane Library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. All zones of injury were included. Articles were classified based on the protocol used during early rehabilitation. We analyzed clinical outcomes, focusing on incidence of tendon rupture and postoperative functional range of motion. We also analyzed the chronological incidence of published tendon rupture with respect to the protocol used. Results: We identified 170 articles, and 34 met our criteria, with evidence ranging from level I to level IV. Early passive motion, including both Duran and Kleinert type protocols, results included 57 ruptures (4%) and 149 fingers (9%) with decreased range of motion of 1598 tendon repairs. Early active motion results included 75 ruptures (5%) and 80 fingers (6%) with decreased range of motion of 1412 tendon repairs. Early passive range of motion protocols had a statistically significantly decreased risk for tendon rupture but an increased risk for postoperative decreased range of motion compared to early active motion protocols. When analyzing published articles chronologically, we found a statistically significant trend that overall (passive and active rehabilitation) rupture rates have decreased over time. Conclusions: Analyzing all flexor tendon zones and literature of all levels of evidence, our data show a higher risk of complication involving decreased postoperative digit range of motion in the passive protocols and a higher risk of rupture in early active motion protocols. However, modern improvements in surgical technique, materials, and rehabilitation may now allow for early active motion rehabilitation that can provide better postoperative motion while maintaining low rupture rates. Type of study/level of evidence: Therapeutic IV.
AB - Purpose: To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion. Methods: We searched PubMed and Cochrane Library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. All zones of injury were included. Articles were classified based on the protocol used during early rehabilitation. We analyzed clinical outcomes, focusing on incidence of tendon rupture and postoperative functional range of motion. We also analyzed the chronological incidence of published tendon rupture with respect to the protocol used. Results: We identified 170 articles, and 34 met our criteria, with evidence ranging from level I to level IV. Early passive motion, including both Duran and Kleinert type protocols, results included 57 ruptures (4%) and 149 fingers (9%) with decreased range of motion of 1598 tendon repairs. Early active motion results included 75 ruptures (5%) and 80 fingers (6%) with decreased range of motion of 1412 tendon repairs. Early passive range of motion protocols had a statistically significantly decreased risk for tendon rupture but an increased risk for postoperative decreased range of motion compared to early active motion protocols. When analyzing published articles chronologically, we found a statistically significant trend that overall (passive and active rehabilitation) rupture rates have decreased over time. Conclusions: Analyzing all flexor tendon zones and literature of all levels of evidence, our data show a higher risk of complication involving decreased postoperative digit range of motion in the passive protocols and a higher risk of rupture in early active motion protocols. However, modern improvements in surgical technique, materials, and rehabilitation may now allow for early active motion rehabilitation that can provide better postoperative motion while maintaining low rupture rates. Type of study/level of evidence: Therapeutic IV.
KW - Early active motion
KW - flexor tendon repair
KW - postoperative care
KW - rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=84883176531&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84883176531&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2013.06.025
DO - 10.1016/j.jhsa.2013.06.025
M3 - Article
C2 - 23981421
AN - SCOPUS:84883176531
VL - 38
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
SN - 0363-5023
IS - 9
ER -