AAHS - Digital Nerve Repair with Flexor Tendon Injury: Conduit Efficacy Does Not Change

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Digital Nerve Repair with Flexor Tendon Injury: Conduit Efficacy Does Not Change
Jonathan Isaacs, MD
Department of Orthopaedics, Virginia Commonwealth University, Richmond, VA

Background: Digital nerve injuries resulting in gaps not amendable to direct coaptation are frequently reconstructed utilizing conduits or Processed Nerve Allograft (PNA). Concurrent flexor tendon repair necessitates the incorporation of a post operative rehab protocol. The effects of this early mobilization on digital nerve regeneration following PNA or conduit reconstruction are not known. Applicable data comparing digital nerve repairs with and without concurrent flexor tendon repairs have been collected as part of the RECON trial�a multi-center, prospective, randomized study comparing reconstructions with processed nerve allografts and hollow synthetic collagen conduits. We hypothesized that early mobilization would compromise the critical conduit fibrin clot necessary for axon regeneration and negatively affect conduit efficacy.

Methods: During the RECON trial, collected patient data included static 2-point discrimination (S2PD) and Semmes Weinstein Monofiliament testing (SWMF) following digital nerve reconstruction for gap defects of 5-25mm with either PNA or conduits. Additional data included concurrent procedures such as flexor tendon repair and participation in rehab protocols. Patients and assessors were blinded to nerve repair method and assessments were performed at presentation though their last evaluable visit (LEV) at 6-to-15 months postoperative. We used independent sample t-tests and Fisher's exact tests for categorical data to compare outcomes with respect to concurrent tendon repair across all reconstruction techniques.

Results: A total of 182 enrollees were included in analysis. Of these, 67 patients suffered concomitant flexor tendon and digital nerve injuries. 35 and 32 of these patients received PNA and collagen conduits for their nerve repairs respectively. 55 and 60 of the patients not treated for flexor tendon injuries received PNA and conduits. The S2PD for the tendon repair group was 10.1mm versus 9.0mm for those without tendon involvement. For the patients that underwent tendon repair, S2PD was 9.9mm in the PNA group and 10.3mm in the conduit group (not statistically different). S3+ or better was achieve following 65.7% of the PNA and 71.9% conduit reconstructions in the flexor tendon repair group (not statistically different). A significantly lower percentage of conduit repairs achieved ASSH classification normal and fair in patients with tendon injuries (50%) versus those without tendon injury (73.3%) (p=0.038).

Conclusions: Following digital nerve gap reconstruction in a large multi-center prospective, randomized trial, concurrent flexor tendon repair with early mobilization did not substantially compromise conduit efficacy.

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