Objective: There has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated. Methods: 128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair. Results: Excellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20. Conclusion: The low rupture rate (2.3%) and 91.4% ‘good’ and ‘excellent’ scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available.
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Chauhan A, Palmer BA, Merrell GA. Flexor tendon repairs: techniques, eponyms, and evidence. J Hand Surg Am. 2014;39:1846e1853.
Wu YF, Tang JB. Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair. J Hand Surg Eur Vol. 2014;39:6e19.
Maki Y. Primary flexor tendon repair and early mobilization. Hand Surg. 2014;19:327e328.
Xie RG, Cao Y, Xu XF, et al. The gliding force and work of flexion in the early days after primary repair of lacerated flexor tendons: an experimental study. J Hand Surg Eur Vol. 2008;33:192e196.
Yang C, Zhao C, Amadio PC, et al. Total and intrasynovial work of flexion of human cadaver flexor digitorum profundus tendons after modified Kessler and MGH repair techniques. J Hand Surg Am. 2005;30:466e470.
Dy CJ, Hernandez-Soria A, Ma Y, et al. Complications after flexor tendon repair: a systematic review and meta-analysis. J Hand Surg Am. 2012;37:543e551.
Tang JB. Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2. J Hand Surg Eur Vol. 2007;32:118e129.
Osei DA, Stepan JG, Calfee RP, et al. The effect of suture caliber and number of core suture strands on zone II flexor tendon repair: a study in human cadavers. J Hand Surg Am. 2014;39:262e268.
Momose T, Amadio PC, Zhao C, et al. The effect of knot location, suture material, and suture size on the gliding resistance of flexor tendons. J Biomed Mater Res. 2000;53:806e811.
Hardwicke JT, Tan JJ, Foster Ma, et al. A systematic review of 2-strand versus multistrand core suture techniques and functional outcome after digital flexor tendon repair. J Hand Surg Am. 2014;39:686e695.
Starr HM, Snoddy M, Hammond KE, et al. Flexor tendon repair rehabilitation protocols: a systematic review. J Hand Surg Am. 2013;38:1712e1717, 14.
Trumble TE, Vedder NB, Seiler JG, et al. Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy. J Bone Joint Surg Am. 2010;92:1381e1389.
Kitis A, Buker N, Kara IG. Comparison of two methods of controlled mobilisation of repaired flexor tendons in Zone 2. Scand J Plast Reconstr Surg Hand Surg. 2009;43:160e165.
Viinikainen A, Goransson H, Ryhanen J. Primary € flexor tendon repair techniques. Scand J Surg. 2008;97:333e340.
Dy CJ, Daluiski A. Update on zone II flexor tendon injuries. J Am Acad Orthop Surg. 2014;22:791e799.
Braga-Silva J, Kuyven CRM. Early active mobilization after flexor tendon repairs in zone two. Chir Main. 2005;24:165e168.
Frueh FS, Kunz VS, Gravestock IJ, et al. Primary flexor tendon repair in zones 1 and 2: early passive mobilization versus controlled active motion. J Hand Surg Am. 2014;39:1344e1350.
Gibson PD, Sobol GL, Ahmed IH. Zone II flexor tendon repairs in the United States: trends in current management. J Hand Surg Am. 2017;42:e99ee108.
Powell ES, Trail IA. Forces transmitted along human flexor tendons during passive and active movements of the fingers. J Hand Surg Br. 2004;29:386e389.
Walbeehm ET, De Wit T, Hovius SER, et al. Influence of core suture geometry on tendon deformation and gap formation in porcine flexor tendons. J Hand Surg Eur Vol. 2009;34:190e195.
Viinikainen A, Goransson H, Huovinen K, et al. A comparative analysis of the € biomechanical behaviour of five flexor tendon core sutures. J Hand Surg Br. 2004;29:536e543.
Lawrence TM, Davis TRC. A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair. J Hand Surg Am. 2005;30:836e841.
Gil JA, Skjong C, Katarincic JA, et al. Flexor tendon repair with looped Suture . J Hand Surg Am. 2016;41:422e426.
Tang JB. Release of the A4 pulley to facilitate zone II flexor tendon repair. J Hand Surg Am. 2014;39:2300e2307.
Henry M. Zone II: repair or resect the flexor digitorum superficialis? J Hand Surg Am. 2011;36:1073e1074.
Griffin M, Hindocha S, Jordan D, et al. An overview of the management of flexor tendon injuries. Open Orthop J. 2012;6:28e35.