Randomized Clinical Study Comparing Early Active Rehabilitation Program for Flexor Tendon Repair versus Early Passive Rehabilitation Program

Abstract

Restoration of full range of motion of digits and prevention of joint contraction following flexor tendon repair is a challenge. The rehabilitation program evolved from immobilization program to early mobilization techniques. Because of the poor results of the immobilization programs as regard incidence of joint adhesions and contracture, Kleinert et al developed controlled motion protocol based on active extension passive flexion of the injured digit within a dorsal blocking splint. The good results of early passive mobilization encouraged several authors to think about controlled early active mobilization. Their studies yield that early active mobilization has better tendon motion with less adhesions. There is lack of the solid evidence as regard the most suitable rehabilitation protocols following flexor tendon repair. This is due to the limited number of studies comparing different rehabilitation protocols. Also the present studies advocate a specific technique with no comparative group. Even the few controlled studies vary in methods of repair and rehabilitation, and outcome assessment. To our knowledge the only randomized controlled trial comparing early passive rehabilitation with early active rehabilitation is the one done by Trumble et al in 2010. They reached a conclusion that patients on active rehabilitation program had better range of motion with less flexion contractures and greater satisfaction scores than those in a passive rehabilitation protocol. Yet this study was performed upon 4 strand repaired tendons. We conducted our study comparing early active mobilization protocol “place and hold” with early passive mobilization “Modified Kleinert” after standard 2 strand modified Kessler repair in different hand zones. Key words: Flexor tendon, Rehabilitation, flexion deformity, tendon lag.