The evidence-base for the management of flexor tendon injuries of the hand: Review

Hand injuries account for up to 20% of all presentations to emergency departments and cost the National Health Service (NHS) over £100 million per year [1]. Flexor tendon injuries are common and may have debilitating sequalae, with re-operation rates as high as 11% [2], culminating in poor patient-reported outcomes [3]. Early active mobilisation (EAM) protocols are commonly used for post-operative rehabilitation, however, there is no definitive consensus on the ideal rehabilitation regimen. “Place and hold” regimes are also popular and although they contain an active component are not considered EAM. There is no consensus on the ideal flexor tendon repair (FTR) technique. Numerous studies have evaluated the merits of various suture configurations, however, directly comparing such studies is difficult due to significant methodological heterogeneity. Consequently, there may be variability in management between units and suboptimal adherence to best practice [1]. Although the results of ex vivo biomechanical studies correlate with the in vivo biomechanical properties of sutured flexor tendons, the focus of this review will be to summarise the clinical evidence base for primary adult FTR techniques at each anatomical zone to provide a clear overview for the reader and suggestions for future work.