Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98 degrees (40) and 114 degrees (45) at 8weeks postoperatively and at the last follow-up (mean 7months, range 3-98), respectively. Using the Strickland criteria, excellent' or good' function was obtained in 95 (30%) out of 322 fingers at 8weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath-pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert's regime. Level of evidence: III