FEATURE ARTICLE ~ Zone-II Flexor Tendon Repair: A Randomized Prospective Trial of Active Place-and-Hold Therapy Compared with Passive Motion Therapy

Author(s): Trumble TE, Vedder NB, Seiler JG, et al.

Source: J Bone Joint Surg 92 (6): 1381-1389, 2010.


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This is a prospective randomized trial comparing an active therapy program versus a passive motion protocol following zone-II flexor tendon repair.  The authors reviewed 103 patients (119 digits) randomized to either early active motion with place and hold or a passive motion protocol. Range of motion was measured at six, twelve, twenty-six, and fifty-two weeks following repair. Dexterity tests were performed, and a  DASH outcome and satisfaction score were completed at fifty-two weeks.  

Patients treated with the active motion program consistently had greater interphalangeal joint motion versus the passive motion protocol at all time points.  At final follow-up, the interphalangeal joint motion in the active place-and-hold group was a mean of 156˚ ± 25˚ compared with 128˚ ± 22˚ in the passive motion group.  

There were no significant differences in the groups in terms of the DASH scores or dexterity tests.  Smokers, concomitant nerve injury, and multiple digit injuries were associated with less range of motion, larger flexion contractures, and decreased satisfaction scores.  

The authors conclude that active motion therapy provides greater active finger motion than passive motion therapy after zone-II flexor tendon repair without increasing the risk of tendon rupture.  Other co-morbidities noted with these injuries negatively impacted the final outcome of tendon repairs.