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Background: The Pulvertaft weave was described more than 50 years ago and is still used in tendon transfers. The aim of this study was to evaluate the strength of a modified core suture Pulvertaft weave technique and compare it to the original Pulvertaft weave traditionally used in tendon transfer surgery.

Methods: 12 extensor pollicis longus tendons and extensor indices proprius tendons were harvested from fresh frozen cadavers. Six Pulvertaft weaves were performed using FiberWire 4.0 and six core suture tendon weave were performed using FiberLoop 4.0. Biomechanical analysis was performed and stifness, first failure load and ultimate failure load were measured for both set of repairs.

Results: The stiffness of the core suture tendon repair (9.5 N/mm) was greater than that of the Pulvertaft repair (2.5 N/mm) The first failure load of the core suture tendon repairs (68.9 N) was greater than the Pulvertaft repairs (19.2 N) and the ultimate failure load of the core suture tendon repairs (101.8 N) was greater than the Pulvertaft repairs (21.9 N). All of these differences were statistically significant.

Conclusions: The core suture Pulvertaft weave is a modification to the Pulvertaft weave used in tendon transfers. The results of this cadaveric study suggest it is 5 times stronger than the traditional Pulvertaft repair, potentially allowing it to be used with early active motion protocols after tendon transfers.

Background: Flexor tendon rehabilitation protocols minimize repair tension by limiting range of movement to prevent tendon rupture. The resultant muscle contracture inhibits finger extension, increases resistance in tendon gliding distally, and progress to proximal interphalangeal (PIP) joint flexion contracture. This study describes our new rehabilitation protocol, the Tension Reducing Muscle Stretch (TRMS), designed to prevent flexor muscle contracture and obtain full distal tendon excursion.

Methods: We reviewed retrospectively 14 fingers in 13 consecutive patients with primary repair of complete zone I or II flexor digitorum profundus (FDP) tendon rupture were treated with our protocol between 2007 and 2019. Our rehabilitation following FDP 4-strand repairs consisted of three steps. The first step comprised of exercises from traditional protocols such as Duran, Kleinert, Synergistic-wrist-motion, and Place-and-hold. The second step comprised the TRMS exercise to prevent the onset of muscle contracture. Anatomically, FDP tendons arise from the same FDP muscle belly. TRMS involved placing the affected finger in full passive flexion while unaffected fingers were passively extended to full extension. This made the affected FDP muscle stretched. The final step incorporated the early active flexion motion exercise, in which simple fisting was performed, from a fully extended position.

Results: The mean total active motion at the final follow up was 235° (range 170–265). Using the Strickland criteria, eight achieved excellent, four had good, two had fair results. The mean angle of passive extension deficit at the PIP joint at four weeks after surgery was −7° (−30–0), and at the final follow up was −3° (−20–0). No tendon repair was ruptured.

Conclusions: This protocol reduced tension in the affected tendon muscle and encouraged tendon excursion distal to the repair site without complications. It allows full tendon excursion and prevents PIP joint contractures.

Background: The purpose of this study was to report the outcomes of flexor tendon repair in zone II and compare two analytic tests – the original and adjusted Strickland scores – and a global hand function test, the 400-points test.

Methods: We included 31 consecutive patients (35 fingers) with a mean age of 36 years (range 19–82 years) who underwent surgery for a flexor tendon repair in zone II. All patients were treated in the same healthcare facility by the same surgical team. All the patients were followed and evaluated by the same team of hand therapists.

Results: At 3 months after the surgery, we found a good outcome in 26% of patients with the original Strickland score, 66% with the adjusted one and 62% with the 400-points test. Among the 35 fingers, 13 of them were evaluated at 6 months after the surgery. All the scores had improved with 31% good outcomes in the original Strickland score, 77% in the adjusted Strickland score and 87% in the 400-points test. The results were significantly different between the original and adjusted Strickland scores. Good agreement was found between the adjusted Strickland score and the 400-points test.

Conclusions: Our results suggest that flexor tendon repair in zone II remains difficult to assess based solely on an analytic test. It should be combined with an objective global hand function test, such as the 400-points test, which appears to correlate with the adjusted Strickland score.

Level of Evidence: Level IV (Therapeutic)