Technical and biological modifications for enhanced flexor tendon repair.
Clinical outcomes after intrasynovial flexor tendon repair have been substantially improved over the past 2 decades through advances in tendon suture techniques and postoperative rehabilitation methods. Nevertheless, complications such as repair site elongation (i.e., gap formation) and rupture continue to occur frequently. Experimental studies have shown that repair site strength fails to increase in the first 3 weeks after tendon suture. After 3 weeks, the strength and rigidity of the repair site improve significantly, a process that continues for several months. Formation of a repair site gap during the early rehabilitation period has been shown to considerably delay the accrual of repair site strength over time. Thus, it is of prime importance that the method of tendon suture achieves and maintains a stiff and strong repair site during the early healing interval by maintaining close approximation of the tendon stumps and by stimulating, where possible, the intrinsic repair response. In this review, we describe recent efforts to enhance the integrity of the immature repair site. We focus on 2 major areas of advancement: surgical technique modifications and manipulation of the biologic and biochemical environment.
Department of Orthopaedic Surgery, Washington University, St. Louis, MO 63110, USA.
H Mike
HM
Kim
Gregory
G
Nelson
Stavros
S
Thomopoulos
Matthew J
MJ
Silva
Rosalina
R
Das
Richard H
RH
Gelberman
D000818:Animals; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D004867:Equipment Design; D055412:Growth Differentiation Factors / Q000627:therapeutic use; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D013536:Suture Techniques; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength; D014945:Wound Healing
D019485:Bone Morphogenetic Proteins; C499470:GDF7 protein, human; D055412:Growth Differentiation Factors; D036341:Intercellular Signaling Peptides and Proteins