Recent progress in flexor tendon healing: The modulation of tendon healing with rehabilitation variables

Until recently, attempts to optimize the postoperative regimen following intrasynovial flexor tendon repair had been essentially empirical, in that both the time and graduation of the exercise regimen have lacked clear conceptual guidelines. The magnitude of load applied in previous studies had not been clearly controlled, and similarly, the effects of increased repair site excursion and gap formation had not been evaluated in clinically relevant models. Recent experimental in vivo data on the application of force and excursion as independent variables by the authors and other investigators have helped to clarify the respective roles of these two variables. The goal of surgical treatment of intrasynovial flexor tendon lacerations is the achievement of a primary tendon repair of tensile strength sufficient to allow early controlled motion after surgery. The implementation of an appropriate postoperative rehabilitation protocol will, based on the experimental data discussed in this article, decrease the formation of intrasynovial adhesions, facilitate the restoration of the gliding surface, and stimulate the accrual of strength at the repair site.