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Assessment of the finger flexor tendon healing after surgical repair using shear wave elastography and radiofrequency analysis: a longitudinal study
Chih-Chien Hung, M.D.
1; Hsing-Kuo Wang, PhD.
2,31National Taiwan University Hospital Yun-Lin branch, Dou-Liu City, Yun-Lin County, Taiwan; 2Center of Physical Therapy, National Taiwan University Hospital, Taipei City, Taiwan; 3School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
IntroductionFinger flexor tendon injuries are common and often require surgical repair. Theoretically, the strength and fiber orientation of the tendon repair site gradually. Clinically, functional evaluations focused on total active motion and grip power, as well as the healing process of the affected tendons.
Ultrasonography is a valuable tool for evaluating tendon healing. Tendon healing may affect the mechanical properties and microstructural changes, which can be assessed using shear wave elastography and radiofrequency analysis. This study aimed to longitudinally evaluate the morphomechanical characteristics of finger flexor tendons after surgical repair, including tendon stiffness and microstructural changes at the repair site.
Materials and Methods Participants with finger flexor tendon injuries in zones II were recruited. All participants underwent primary surgical repair using 4-0 nylon 6-strand core sutures (modified Kessler + cruciate sutures) and 6-0 nylon continuous
epitendinous running sutures. A dorsal blocking splint was used for protection, and passive range of motion was allowed starting on post
operative day 5, with active flexion allowed for three weeks postoperatively. Ultrasonographic evaluations were performed at 3, 6, 10, 16, and 24 weeks postoperatively.
Shear wave elastography was used to measure the tendon stiffness, and B-mode ultrasound images were analyzed using MATLAB and associated programs to assess the micro
structural changes at the repair site. Repeated-measures measurement ANOVA was used to analyze the data, with a significance level of 0.05.
Results Seven participants (seven affected fingers) were analyzed. Participants' basic information is provided in Figures 1. Figures 2 and 3 show the time sequence changes in tendon stiffness and radiofrequency analysis parameters at the tendon repair site. Our results demonstrate that tendon stiffness increased during healing, whereas tendon fiber disorientation decreased. Conclusions This is the first study using shear wave elastography and radiofrequency analysis that evaluated the healing process of finger flexor tendons after repair in humans. Further research is necessary to increase the number of participants and identify ultrasound parameters for postoperative recovery, as a guidance on rehabilitation.
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