Lengthening the locking loop repair for zone 2 flexor tendon laceration and partial lateral release of the tendon sheath.

The authors present the clinical outcomes of nine zone 2 flexor tendon repairs using a locking loop technique (i.e. the Modified Pennington technique). The locking loops were located approximately 10 mm away from the lacerated tendon ends to "lengthen" the locking loop repair, as experimentally and clinically recommended. The partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, was performed not only to locate the sutures but also to allow a full range of motion of the repair without catching on the tendon sheath, as clinically recommended. All the patients were followed up for six months or more except for one. All digits were evaluated as excellent or good at the final follow-up by the original Strickland criteria. No rupture occurred and no bowstring of the flexor tendon was observed. The clinical outcomes of the current study indicate that "lengthening" the locking loop repair is effective for zone 2 flexor tendon repair and that the partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, does not result in the bowstring of the flexor tendon.

Aggressive active mobilization following zone II flexor tendon repair using a two-strand heavy-gauge locking loop technique.

In vitro and in vivo experimental studies have shown that a new two-strand technique increases the tensile strength of flexor tendon repair and eliminates gap formation at the healing repair site. The purpose of the current study was to clinically evaluate the new technique, followed by an aggressive active mobilization program. Seven digits with zone II flexor tendon lacerations were treated using the technique, employing a heavy (2-0) braided polyester suture. The patients were encouraged to perform active mobilization of the injured digits by themselves with almost a full range of flexion and extension after they were instructed by the surgeon for few days from the first postoperative day. All patients were followed up for at least 6 months, except for one, with whom contact was lost in 14 weeks postoperatively. Six of the seven digits were evaluated as excellent in 6 months by the original Strickland criteria, thus showing that the combination of the new repair technique and aggressive active mobilization is effective for zone II flexor tendon repair.