Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

J Hand Surg Eur Vol. 2016 Oct;41(8):793-801. doi: 10.1177/1753193416657758. Epub 2016 Jul 12.


We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3-98), respectively. Using the Strickland criteria, 'excellent' or 'good' function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath-pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert's regime.

Level of evidence: III.

Keywords: Flexor tendon suture; outcome; predictors of function; reoperations.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Female
  • Finger Injuries / surgery*
  • Finger Joint / physiopathology
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Range of Motion, Articular
  • Recovery of Function
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Suture Techniques
  • Tendon Injuries / surgery*
  • Treatment Outcome
  • Young Adult