PAPER 202: PROSPECTIVE ANALYSIS OF THE FOUR-STRAND CRUCIATE REPAIR COMBINED WITH AN EARLY ACTIVE PROTOCOL FOR ZONE I AND ZONE II FLEXOR TENDON LACERATIONS

Abstract

Purpose: The cruciate four-strand flexor tendon repair technique has been advocated for its ease of use and biomechanical strength. However, the in vivo efficacy of the cruciate 4-strand repair has not been reported; no has this method of repair been assessed for its ability to allow for an early active motion rehabilitation protocol. The purpose of this study was to report early clinical results using the cruciate 4-strand repair for proximal zone I and zone II flexor tendon lacerations.

Method: Thirty-five digits in thirty-one patients had proximal zone I (3 digits) or zone II (32 digits) flexor tendon lacerations which were repaired using the cruciate 4-strand technique and an epitendinous state. Average patient age was 30.8 years (range 9.7–63.7). An early active motion rehabilitation protocol was initiated an average of 1.5 days following tendon repair. The supervised therapy program was continued for 12 weeks post-operatively. Assessment of total active motion (TAM), as well as PIP and DIP TAM, grip strength, and joint contractures were recorded at 3 months and at 6 months or greater post-operatively. Functional assessments (using the Strickland and American Society of Surgery for the Hand criteria) were performed for each patient at 3 and 6 month intervals.

Results: All patients were followed for a minimum three-month period. At 3 months postoperatively, there were 16 excellent, 7 good, 6 fair, and 6 poor results by the Strickland criteria, and 12 excellent, 15 good, 7 fair, and 1 poor by the ASSH criteria. Total active motion averaged 225° (±44°), PIP and DIP motion averaged 136° (±40°). Grip strength was available for 17 patients and averaged 60% of the contralateral, uninvolved hand. By 6 months or greater postoperatively there were 18 digits available for follow-up. There were 15 excellent results and 3 good results by the Strickland criteria, and 11 excellent and 7 good results by the ASSH criteria. Six patients had PIP contractures averaging 11° (range 3–15°), and two patients had DIP contractures averaging 13° (range 5–20°). Total active motion averaged 257° (±22°), and PIP and DIP motion averaged 166° (±22°). Grip strength was available on 14 patients and averaged 91% of the contralateral hand. To date, of the patients followed up to 6 months or longer, there have been no ruptures, no re-operations for tenolysis, and no loss of motion.

Conclusion: Early clinical results using the cruciate 4-strand suture technique for flexor tendon repair have demonstrated outcomes equivalent or superior to other methods. The relative simplicity of the technique, with biomechanical strength properties facilitating a modified early active motion rehabilitation protocol, may make this method of repair attractive. Further clinical studies will need to be performed to determine the long-term efficacy of this method of tendon repair.