The influence of patient and surgical factors on prognosis in repeated flexor tenorrhaphy

Authors

DOI:

https://doi.org/10.2340/jphs.v61.46464

Keywords:

Finger, tendon injuries, rupture, reinjuries, reoperation, prognosis

Abstract

Purpose: This study aimed to investigate factors influencing outcome in patients who experienced re-rupture after flexor tenorrhaphy.

Background: Flexor tendon re-rupture following tenorrhaphy remains a significant complication that can adversely affect functional outcomes and require repeated surgical intervention. This study aimed to investigate factors influencing prognosis in patients who experienced re-rupture after flexor tenorrhaphy.

Materials and Methods: We retrospectively analyzed patients who underwent flexor tendon tenorrhaphy on little fingers between January 2011 and September 2024 and subsequently experienced re-rupture ­followed by a primary repair. We analyzed factors such as re-rupture timing, rupture to surgery interval, patient demographics, medical history, and participation in rehabilitation therapy using a simple linear regression model. Patients with underlying diseases, concurrent fractures, thumb or extensor tendon ruptures, or follow-up periods less than 6 months were excluded. The Adjusted Strickland and Whitaker methods were used for evaluation.

Results: A total of 17 patients out of 313 who underwent flexor tendon repair experienced re-rupture and met the inclusion criteria. Age and re-rupture period significantly affected prognosis. Older patients showed poorer final range of motion outcomes. In contrast, the initiation date, frequency, and duration of rehabilitation therapy did not demonstrate statistically significant correlations with prognosis.

Conclusions: Older age and delayed re-rupture were associated with poorer postoperative finger range of motion following repeated flexor tenorrhaphy. Therefore, patients should be advised to avoid excessive hand use until adequate tendon healing is achieved, and thorough postoperative education may be particularly important in elderly patients.

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References

Taras JS, Gray RM, Culp RW. Complications of flexor tendon injuries. Hand Clin. 1994;10:93–109. DOI: https://doi.org/10.1016/S0749-0712(21)01037-4

Stenekes MW, Rüttermann M, Werker PMN. Rare causes of closed rupture of the flexor tendon. J Plast Surg Hand Surg. 2014;48(3): 219–221. DOI: https://doi.org/10.3109/2000656X.2013.777226

Faccio D, Montanari S, Maschio N, et al. The origins of the camper’s chiasm asymmetry: a cadaveric study and clinical implications for flexor tendons surgery. J Plast Surg Hand Surg. 2023;57(1–6):471–475. DOI: https://doi.org/10.1080/2000656X.2022.2158844

Lilly SI, Messer TM. Complications after treatment of flexor tendon injuries. J Am Acad Orthop Surg. 2006;14:387–396. DOI: https://doi.org/10.5435/00124635-200607000-00001

Netscher DT, Badal JJ. Closed flexor tendon ruptures. J Hand Surg. 2014;39:2315–2323. DOI: https://doi.org/10.1016/j.jhsa.2014.04.005

Rubensson CC, Ydreborg K, Boren L, et al. Flexor tendon repair after rupture caused by volar plate fixation of the distal radius. J Plast Surg Hand Surg. 2015;49(2):112–115. DOI: https://doi.org/10.3109/2000656X.2014.951050

Leddy JP. Operative hand surgery , 4th edition. In: Green DP, editor. New York, Edinburgh, London, and Melbourne: Churchill Livingstone; 1982. p. 1360–1363.

Allen BN, Frykman GK, Unsell RS, et al. Ruptured flexor tendon tenorrhaphies in zone II: repair and rehabilitation. J Hand Surg. 1987;12:18–21. DOI: https://doi.org/10.1016/S0363-5023(87)80153-3

LaSalle WB, Strickland JW. An evaluation of the two-stage flexor tendon reconstruction technique. J Hand Surg. 1983;8:263–267. DOI: https://doi.org/10.1016/S0363-5023(83)80155-5

Gorriz GJA, Cooke J. Assessment of the influence of the timing of repair on flexor tendon injuries in chickens. Br J Plast Surg. 1976;29:82–84. DOI: https://doi.org/10.1016/0007-1226(76)90099-0

Galatz LM, Gerstenfeld L, Heber-Katz E, et al. Tendon regeneration and scar formation: the concept of scarless healing. J Orthop Res. 2015;33:823–831. DOI: https://doi.org/10.1002/jor.22853

Kleinert HE, Verdan C. Report of the committee on tendon injuries. J Hand Surg. 1983;8:794–798. DOI: https://doi.org/10.1016/S0363-5023(83)80275-5

Paneva-Holevich E. Two-stage reconstruction of the flexor tendons. Int Orthop. 1982;6:133–138. DOI: https://doi.org/10.1007/BF00268657

Strickland JW. Delayed treatment of flexor tendon injuries including grafting. Hand Clin. 2005;21:219–243. DOI: https://doi.org/10.1016/j.hcl.2004.12.003

Lee KC, Lee DC, Kim JS, et al. Loop suture technique for flexor digitorum profundus tendon repair in the insertion site. J Korean Soc Plast Reconstr Surg. 2010:650–658.

Uslu M, Isik C, Ozsahin M, et al. Flexor tendons repair: effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model. Orthop Traumatol Surg Res. 2014;100:611–616. DOI: https://doi.org/10.1016/j.otsr.2014.05.009

Elliot D, Giesen T. Primary flexor tendon surgery. Hand Clin. 2013;29:191–206. DOI: https://doi.org/10.1016/j.hcl.2013.03.001

Rrecaj S, Martinaj M, Murtezani A, et al. Physical therapy and splinting after flexor tendon repair in zone II. Med Arch. 2014;68:128–131. DOI: https://doi.org/10.5455/medarh.2014.68.128-131

Tang JB. Recent evolutions in flexor tendon repairs and rehabilitation. J Hand Surg Eur Vol. 2018;43:469–473. DOI: https://doi.org/10.1177/1753193418773008

Nichols AEC, Best KT, Loiselle AE. The cellular basis of fibrotic tendon healing: challenges and opportunities. Transl Res. 2019;209:156–168. DOI: https://doi.org/10.1016/j.trsl.2019.02.002

Voleti PB, Buckley MR, Soslowsky LJ. Tendon healing: repair and regeneration. Ann Rev Biomed Eng. 2012;14:47–71. DOI: https://doi.org/10.1146/annurev-bioeng-071811-150122

Zhao C, Amadio PC, Momose T, et al. Effect of synergistic wrist motion on adhesion formation after repair of partial flexor digitorum profundus tendon lacerations in a canine model in vivo. J Bone Joint Surg Am. 2002;84:78–84. DOI: https://doi.org/10.2106/00004623-200201000-00012

Svingen J, Wiig M, Turesson C, et al. Risk factors for reoperation after flexor tendon repair: a registry study. J Hand Surg Eur Vol. 2022;47: 1071–1076. DOI: https://doi.org/10.1177/17531934221101563

Ackerman JE, Bah I, Jonason JH, et al. Aging does not alter tendon mechanical properties during homeostasis, but does impair flexor tendon healing. J Orthop Res. 2017;35:2716–2724. DOI: https://doi.org/10.1002/jor.23580

Karousou E, Ronga M, Vigetti D, et al. Collagens, proteoglycans, MMP-2, MMP-9 and TIMPs in human Achilles tendon rupture. Clin Orthop Relat Res. 2008;466:1577–1582. DOI: https://doi.org/10.1007/s11999-008-0255-y

Kasashima T, Kato H, Minami A. Factors influencing prognosis after direct repair of the flexor pollicis longus tendon: multivariate regression model analysis. Hand Surg. 2002;07:171–176. DOI: https://doi.org/10.1142/S0218810402001126

Tottenham VM, Wilton-Bennett K, Jeffrey J. Effects of delayed therapeutic intervention following zone II flexor tendon repair. J Hand Ther. 1995;8:23–26. DOI: https://doi.org/10.1016/S0894-1130(12)80152-9

Gelberman RH, Woo SL, Lothringer K, et al. Effects of early intermittent passive mobilization on healing canine flexor tendons. J Hand Surg Am. 1982;7:170–175. DOI: https://doi.org/10.1016/S0363-5023(82)80083-X

Bishop AT, Cooney WPI, Wood MB. Treatment of partial flexor tendon lacerations: the effect of tenorrhaphy and early protected mobilization. J Trauma Acute Care Surg. 1986;26:301. DOI: https://doi.org/10.1097/00005373-198604000-00001

Boyer MI, Strickland JW, Engles D, et al. Flexor tendon repair and rehabilitation: state of the art in 2002. Instr Course Lect. 2003;52:137–161.

Hurley CM, Reilly F, Callaghan S, et al. Negative predictors of outcomes of flexor tendon repairs. Cureus. 2019;11:e4303. DOI: https://doi.org/10.7759/cureus.4303

Santiago-Torres J, Flanigan DC, Butler RB, et al. The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. Am J Sports Med. 2015;43:745–751. DOI: https://doi.org/10.1177/0363546514533776

Lee JJ, Patel R, Biermann JS, et al. The musculoskeletal effects of cigarette smoking. J Bone Joint Surg. 2013;95:850–859. DOI: https://doi.org/10.2106/JBJS.L.00375

Sandford F, Barlow N, Lewis J. A study to examine patient adherence to wearing 24-hour forearm thermoplastic splints after tendon repairs. J Hand Ther. 2008;21:44–53. DOI: https://doi.org/10.1197/j.jht.2007.07.004

Vaidya R, Lake SP, Zellers JA. Effect of diabetes on tendon structure and function: not limited to collagen crosslinking. J Diabetes Sci Technol. 2023;17:89–98. DOI: https://doi.org/10.1177/19322968221100842

Lin TW, Cardenas L, Soslowsky LJ. Biomechanics of tendon injury and repair. J Biomech. 2004;37:865–877. DOI: https://doi.org/10.1016/j.jbiomech.2003.11.005

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. 2014;39:686.e2–695.e2. DOI: https://doi.org/10.1016/j.jhsa.2013.12.037

Chung M-J, Wang M-JJ. The effect of age and gender on joint range of motion of worker population in Taiwan. Int J Ind Ergon. 2009;39:596–600. DOI: https://doi.org/10.1016/j.ergon.2007.11.004

Published

2026-09-10

How to Cite

Park, J. J., Roh, S. Y., Koh, S. H., Lee, D. C., Kim, J. S., & Lee, K. J. (2026). The influence of patient and surgical factors on prognosis in repeated flexor tenorrhaphy. Journal of Plastic Surgery and Hand Surgery, 61(1), 237–242. https://doi.org/10.2340/jphs.v61.46464

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Original Research Articles