Outcome of Surgical Repair and Rehabilitation of Flexor Tendon Injuries in Zone II of the Hand: Systematic Review and Meta-Analysis

Abstract

Purpose: We performed a systematic review and meta-analysis to determine an optimal rehabilitation protocol following surgical repair for flexor tendon injury in zone II of the hand.

Methods: Records from PubMed, Embase, and Cochrane were retrieved from their establishment to January 12, 2020. Seven studies were included in the final analysis. A total of 569 digits with a flexor tendon injury in zone II of the hand were included in this meta-analysis: 135 in a place and hold group; 161 in an active flexion and extension group; and 273 in an early passive motion group.

Results: There was no significant difference between the place and hold and early passive motion regimes in the incidence of rupture. There was a significant difference between the active flexion and extension and early passive motion regimes in the incidence of rupture. In the early active motion group, the possibility of 1 or more grades of improvement on the Strickland grading system was increased.

Conclusions: The early active motion group obtained greater total active motion than the early passive motion group. A higher risk of rupture was noted in the active flexion and extension subgroup repaired by 2-strand core suture. The 2-strand technique was not sufficient for active flexion and extension protocols. Further study in multistrand tendon repair technique with early active exercise in zone II should be undertaken to determine its efficacy.

Type of study/level of evidence: Therapeutic IV.

Keywords: Early active motion; early passive motion; flexor tendon repair; postoperative rehabilitation protocol; zone II.