title: Primary flexor tendon repair in zones 1 and 2: early passive mobilization versus controlled active motion.
abstract: OBJECTIVE
  To compare early passive mobilization (EPM) with controlled active motion (CAM) after flexor tendon surgery in zones 1 and 2.
  
  
  METHODS
  We performed a retrospective analysis of collected data of all patients receiving primary flexor tendon repair in zones 1 and 2 from 2006 to 2011, during which time 228 patients were treated, and 191 patients with 231 injured digits were eligible for study. Exclusion criteria were replantation, finger revascularization, age younger than 16 years, rehabilitation by means other than EPM or CAM, and missing information regarding postoperative rehabilitation. This left 132 patients with 159 injured fingers for analysis. The primary endpoint was the comparison of total active motion (TAM) values 4 and 12 weeks after surgery between the EPM and the CAM protocols. The analysis of TAM measurements under the rehabilitation protocols was conducted using t-tests and further linear modeling. We defined rupture rate and the assessment of adhesion/infection as secondary endpoints.
  
  
  RESULTS
  There was a statistically significant difference between the TAM values of the EPM and the CAM protocols 4 weeks after surgery. At 12 weeks, however, there was no significant difference between the 2 protocols. Older age and injuries with finger fractures were associated with lower TAM values. Rupture rates were 5% (CAM) and 7% (EPM), which were not statistically different.
  
  
  CONCLUSIONS
  This study showed a favorable effect of CAM protocol on TAM 4 weeks after surgery. The percent rupture rate was slightly lower in the patients with CAM than in the patients with EPM regime. Further studies are required to confirm our results and to investigate whether faster recovery of TAM is associated with shorter time out of work.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland. Electronic address: florian.frueh@usz.ch.
authors.forename: Florian Samuel
authors.initials: FS
authors.lastname: Frueh
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Viviane Sylvie
authors.initials: VS
authors.lastname: Kunz
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Isaac Joseph
authors.initials: IJ
authors.lastname: Gravestock
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Leonhard
authors.initials: L
authors.lastname: Held
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Haefeli
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Calcagni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods / Q000534:rehabilitation; D011182:Postoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013708:Tendon Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: CAM; Kleinert protocol; early active mobilization; flexor tendon repair; zone 2