Outcomes of Primary Flexor Tendon Repairs in Zones 2 and 3: A Retrospective Cohort Study

Bernadette Christina Tobler-Ammann; Vera Beckmann-Fries; Maurizio Calcagni; Alexandre Kämpfen; Lorena Schrepfer; Esther Vögelin

doi:10.1016/j.jhsg.2023.03.016

Outcomes of Primary Flexor Tendon Repairs in Zones 2 and 3: A Retrospective Cohort Study

J Hand Surg Glob Online. 2023 May 18;5(4):445-453. doi: 10.1016/j.jhsg.2023.03.016. eCollection 2023 Jul.

Authors

Bernadette Christina Tobler-Ammann¹, Vera Beckmann-Fries², Maurizio Calcagni³, Alexandre Kämpfen⁴, Lorena Schrepfer⁴, Esther Vögelin¹

Affiliations

¹ Department of Plastic and Hand Surgery, Inselspital Bern, University of Bern, Bern, Switzerland.
² Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland.
³ Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
⁴ Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.

Abstract

Purpose: The aims of this retrospective cohort study were to present outcomes of zone 2 and 3 primary flexor tendon repairs and to evaluate how clinical outcomes change over time within and between zones of injury at weeks 6, 13, and 26.

Methods: Data were retrieved from a multicenter flexor tendon cohort registry from 2014 to 2021. The inclusion criteria were: (1) adult patients after primary flexor tendon surgery in zone 2 or 3, (2) flexor digitorum profundus laceration of >50%, (3) 4-6 multistrand flexor digitorum profundus core suture, and (4) early active motion protocol. The primary outcome was the range of motion. Secondary outcomes were strength, patient satisfaction on an 11-point Likert scale, and self-reported physical function measured with the Disability of the Arm, Shoulder, and Hand questionnaire 6, 13, and 26 weeks after surgery.

Results: We evaluated 33 patients after 39 tendon repairs in zone 3 and 174 repairs in zone 2 of 163 patients. Range of motion significantly improved over time in both zones (P < .001 to .01). Between-group range of motion differences were nonsignificant except for week 26 (P < .001) for the zone 3 group. Hand strength significantly improved in both zones over time (P < .001 to .01), while between-zone strength differences were statistically nonsignificant (P = .37 to .93). Patient satisfaction was generally good to high (mean 6.8 to 8.0 points) with significant within-group changes in both zones (P < .001). There were no relevant between-zone differences in Disability of the Arm, Shoulder, and Hand scores at any time point.

Conclusions: Patients had significantly improved clinical outcomes in both zones. The zone of injury significantly affected the total active motion scores at the final assessment after 26 weeks for the zone 3 injuries. For the secondary outcomes hand strength, patient satisfaction, and Disability of the Arm, Shoulder, and Hand scores, we discovered no significant between-group differences.

Type of study/level of evidence: Therapeutic IV.

Keywords: Clinical outcomes; Cohort; Flexor tendon injury; Zone 2; Zone 3.