Clinical Outcomes following flexor tenolysis following isolated flexor tendon repair
Christian M Shigley, MD1, Nate Benner, MD1, Chelsea Boe, MD1 and Jerry I Huang, MD2, (1)University of Washington, Seattle, WA, (2)Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
Introduction:
Complications following hand flexor tendon repairs are common, with reoperations due to tendon rupture or adhesions being the most common, with stiffness occurring in 4-10% of patients. Impaired active finger flexion occurs due to adhesions between the flexor tendons and its fibro-osseous sheath and the underlying proximal phalanx. In patients who have plateaued with therapy, flexor tenolysis can be an effective surgical option. There is a paucity of literature on outcomes of flexor tenolysis in flexor tendon lacerations. This study aims to review clinical outcomes and complications in patients who underwent flexor tenolysis following Zone 2 and Zone 3 flexor tendon repairs.
Methods:
Chart review was performed on all patients treated from 2010-2020 at our institution who had undergone flexor tenolysis and/or contracture release for finger stiffness following flexor tendon repair were identified. We excluded patients with injuries in Zones 1, 4, and 5, as well as patients undergoing pulley reconstruction. Clinical outcomes data including demographics, range of motion and pain scores were collected. Complications including reoperation, tendon rupture, infection, recurrent joint contracture, and digital nerve injuries were also reviewed. Data were analyzed using multivariate regression.
Results:
There were 118 fingers that underwent flexor tenolysis in 74 patients with a mean age of 45.0. Preoperatively, patients had a mean flexion contracture of 33.8 degrees at the PIP joint with mean active flexion of 56.4 degrees with passive flexion to 84 degrees. At the 3-month follow-up, the mean PIP joint flexion contracture was 17 degrees with mean active flexion to 72 degrees. At the final follow-up, the total arc of motion (TAM) improved significantly from 123 degrees to 171 degrees (p<0.05). The mean VAS pain score was 1.5. Concomitant dorsal PIP capsulotomy was performed on 17 patients. Revision flexor tenolysis was performed on 19 patients. There were no digital nerve injuries but paresthesia in the fingers persisted in 7 of 118 digits. There were 6 cases of post-operative infection and 2 cases of flexor tendon rupture.
Conclusion:
Finger stiffness following flexor tendon repairs is quite common following zone 2 and 3 injuries, especially in patients with concomitant digital nerve repairs. Flexor tenolysis is a challenging procedure, but can result in modest improvements in active range of motion in most patients. Paresthesias are common following the procedure, occurring in 10% of the cases. The risk of flexor tendon rupture is a rare complication that should be discussed with the patient pre-operatively.
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