Flexor Tendon Repair Techniques and Clinical Outcomes

The healing of flexor tendons in the hand has been the subject of extensive investigation, driven by the need to restore digital function following injury. Primary repair within 12 to 24 hours remains the standard of care, with techniques evolving from simple two-strand core sutures to complex multi-strand constructs designed to optimise strength while minimising bulk. Contemporary methods—such as four- and eight-strand core sutures combined with epitendinous repairs—seek to balance tensile resistance with gliding capacity within the tendon sheath. Early active mobilisation protocols have demonstrated superiority over passive regimes in promoting collagen alignment and reducing adhesions, albeit at the cost of a small but significant risk of repair gap formation or rupture. Key challenges persist in achieving sufficient repair strength to permit functional rehabilitation without provoking adhesion formation, which can severely limit range of motion. Recent innovations include barbed suture materials, suture anchor systems for avulsion injuries and surface-locking techniques that further enhance load to failure. Outcomes are influenced by injury zone, suture technique, rehabilitation strategy and patient factors such as age and comorbidities. Despite high rates of return to function, complications of re-rupture, tenolysis and joint stiffness underline the ongoing need for refinement of surgical and postoperative protocols.

Research from Nature Portfolio

Recent biomechanical studies have examined anchor-based repair of type IV flexor digitorum profundus avulsion injuries using suture anchors implanted into the distal phalanx. Ex vivo repetitive loading and load-to-failure tests have demonstrated superior mechanical stability of the anchor construct compared with traditional pull-out sutures, exhibiting minimal gap formation at both bone–bone and bone–tendon interfaces. These findings suggest that suture anchor techniques may allow for earlier controlled mobilisation and reduced implant-related complications, warranting translation into clinical trials to validate functional outcomes and long-term tendon integrity.

Flexor Tendon Repair Techniques and Clinical Outcomes publication trend

The graph below shows the total number of articles in flexor tendon repair techniques and clinical outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Core suture: The primary stitch within the tendon substance that provides tensile strength to the repair.

Epitendinous suture: A circumferential stitch placed around the tendon surface to augment core repair and smooth the repair site.

Adhesion formation: Pathological fibrous bands that restrict tendon gliding within its sheath.

Gap formation: Separation at the repair site under load, commonly defined as 2 mm or more of displacement.

Early active mobilisation: Rehabilitation protocol that initiates controlled tendon movement shortly after surgery to promote collagen alignment and reduce adhesions.

References

1. Current clinical opinion on surgical approaches and rehabilitation of hand flexor tendon injury—a questionnaire study. Frontiers in Medical Technology (2024).
2. A suture anchor-based repair technique for type IV jersey finger injuries: a biomechanical investigation. Scientific Reports (2023).
3. The evidence-base for the management of flexor tendon injuries of the hand: Review. Annals of Medicine and Surgery (2019).
4. Risk factors for reoperation after flexor tendon repair: a registry study. Journal of Hand Surgery (European Volume) (2022).
5. Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. Journal of Orthopaedics and Traumatology (2015).
6. The effect of modified locking methods and suture materials on Zone II flexor tendon repair—An ex vivo study. PLOS ONE (2018).