Comparative study between early active and passive rehabilitation protocols following two-strand flexor tendon repair : can two-strand flexor tendon repair withstands early active rehabilitation ?

• Published in: Egyptian Rheumatology and Rehabilitation Vol. 45; no. 4; pp. 125 - 132
• Main Authors: al-Banna, Muhyi, Labib, Amir, Abd al-Sabur, Halah M., Abd al-Salam, Ahmad
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt The Egyptian Society for Rheumatology and Rehabilitation 01-10-2018; Springer Berlin Heidelberg; Wolters Kluwer India Pvt. Ltd; Springer Nature B.V; SpringerOpen
• Subjects: flexion deformity; flexor tendon repair; Medicine & Public Health; modified Kleinert; Original Article; Range of motion; Rehabilitation; tendon lag; Tendons; two-strand suture; flexion deformity; flexor tendon repair; rehabilitation; modified Kleinert; two-strand suture; tendon lag
• ISSN: 1110-161X; 2090-3235
• DOI: 10.4103/err.err_15_18

Restoration of full range of motion of digits as well as prevention of joint contracture
following flexor tendon repair is a challenge. There is lack of solid evidence
regarding the most suitable rehabilitation protocol following flexor tendon repair.
This is owing to the limited number of studies comparing different rehabilitation
protocols. Moreover, the present studies advocate a specific technique with no
comparative group. Even the few controlled studies conducted vary in methods of
repair and rehabilitation, and outcome assessment. To our knowledge, the only
randomized controlled trial comparing early passive rehabilitation with early active
rehabilitation is the one done by Trumble and colleagues in 2010, which was done
on four-strand repaired tendon. These authors concluded that active rehabilitation
program had better range of motion with less flexion contractures and greater
satisfaction scores than those subjected to passive rehabilitation protocol.
Aim
This conclusion stimulated us to study the effect of early active mobilization versus
early passive mobilization following two-strand repair.
Patient and methods
We conducted our study for 12 weeks comparing early active mobilization protocol
‘place and hold’ with early passive mobilization ‘modified Kleinert’ after standard
two-strand modified Kessler repair in different hand zones.
Results and conclusion
We concluded that early active mobilization had better tendon gliding and excursion
even with the two-strand repair as active motion will decrease adhesion formation,
with significant difference compared with the passive group. Moreover, there was
no significant difference in the rupture rate and significant difference for combined
tendon lag and flexion deformity owing to the tenodesis mobilization between both
the groups.