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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(05): e681-e688
DOI: 10.1055/s-0043-1776133
Revisão Sistemática e Metanálise
Mão

Early or Delay? The Most Suitable Rehabilitation Protocol for “No Man's Land” Injury: Meta-Analysis with Trial Sequential Analysis – 20 Years Trends

Artikel in mehreren Sprachen: português | English
Celleen Rei Setiawan 
1   Residente do Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Universidade Udayana, Denpasar, Bali, Indonésia
,
Made Bramantya Karna
2   Equipe do Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Universidade Udayana, Denpasar, Bali, Indonésia
› Institutsangaben Financial Support The authors declare that they have not received any no financial support from public, commercial, or non-profit sources to conduct the present study.
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Abstract

Objective The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome.

Methods The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA).

Result The mean of re-rupture rate is 3.3% (n = 8) in the combination protocol until 8% (n = 48) in CAM protocol. Meta-analyses found no significant difference between Kleinert vs CAM in re-rupture rate. Also no significant difference in Duran vs CAM in rerupture rate. In Trial Sequential Analysis (TSA), the z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM vs Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture. For the range of mean flexion contracture 6.6% (n = 18) in CAM to 23.6% (n = 76) in Kleinert protocol.

Conclusion Current meta-analysis proposed that the combination technique will result less re-rupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results less flexion contracture than others. However, a further meta-analyses with larger sample trials will be required to confirm this review's conclusion.

Keywords

tendon injuries - postoperative care - surgical procedures, operative

Work developed in the Orthopaedics and Traumatology Department, Sanglah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia




Publikationsverlauf

Eingereicht: 16. Mai 2022

Angenommen: 05. Mai 2023

Artikel online veröffentlicht:
30. Oktober 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Braga-Silva J, Kuyven CR. Early active mobilization after flexor tendon repairs in zone two. Chir Main 2005; 24 (3-4): 165-168
    CrossrefPubMedSuche in Google Scholar
  • 2 Hung LK, Pang KW, Yeung PL, Cheung L, Wong JM, Chan P. Active mobilisation after flexor tendon repair: comparison of results following injuries in zone 2 and other zones. J Orthop Surg (Hong Kong) 2005; 13 (02) 158-163
    CrossrefPubMedSuche in Google Scholar
  • 3 Riaz M, Hill C, Khan K, Small JO. Long term outcome of early active mobilization following flexor tendon repair in zone 2. J Hand Surg [Br] 1999; 24 (02) 157-160
    CrossrefPubMedSuche in Google Scholar
  • 4 Baktir A, Türk CY, Kabak S, Sahin V, Kardaş Y. Flexor tendon repair in zone 2 followed by early active mobilization. J Hand Surg Br 1996; 21 (05) 624-628
    CrossrefPubMedSuche in Google Scholar
  • 5 Bainbridge LC, Robertson C, Gillies D, Elliot D. A comparison of post-operative mobilization of flexor tendon repairs with “passive flexion-active extension” and “controlled active motion” techniques. J Hand Surg Br 1994; 19 (04) 517-521
    CrossrefPubMedSuche in Google Scholar
  • 6 Cetin A, Dinçer F, Keçik A, Cetin M. Rehabilitation of flexor tendon injuries by use of a combined regimen of modified Kleinert and modified Duran techniques. Am J Phys Med Rehabil 2001; 80 (10) 721-728
    CrossrefPubMedSuche in Google Scholar
  • 7 Silfverskiöld KL, May EJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg Am 1994; 19 (01) 53-60
    CrossrefPubMedSuche in Google Scholar
  • 8 Schenck RR, Lenhart DE. Results of zone II flexor tendon lacerations in civilians treated by the Washington regimen. J Hand Surg Am 1996; 21 (06) 984-987
    CrossrefPubMedSuche in Google Scholar
  • 9 Abdel Sabour HM, Labib A, Sallam AA. et al. Comparative study between early active and passive rehabilitation protocols following two-strand flexor tendon repair: can two-strand flexor tendon repair withstands early active rehabilitation?. Egypt Rheumatol Rehabil 2018; 45: 125-132
    CrossrefSuche in Google Scholar
  • 10 Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. An overview of the management of flexor tendon injuries. Open Orthop J 2012; 6: 28-35
    CrossrefPubMedSuche in Google Scholar
  • 11 Kannan PG, Dhanaraju S. Prognostic indicators affection functional outcome in zone ii flexor tendon repairs. Int Surg J 2018; 5 (11) 3613-3616
    CrossrefSuche in Google Scholar
  • 12 Duran R, Houser R. Controlled passive motion following flexor tendon repair in zones 2 and 3. In: AAOS symposium on tendon surgery in the hand. St Louis: Mosby; 1975: 105-114
    Suche in Google Scholar
  • 13 Kleinert HE, Kutz JE, Atasoy E, Stormo A. Primary repair of flexor tendons. Orthop Clin North Am 1973; 4 (04) 865-876
    CrossrefPubMedSuche in Google Scholar
  • 14 Elliot D, Moiemen NS, Flemming AF, Harris SB, Foster AJ. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg [Br] 1994; 19 (05) 607-612
    CrossrefPubMedSuche in Google Scholar
  • 15 Frueh FS, Kunz VS, Gravestock IJ. et al. Primary flexor tendon repair in zones 1 and 2: early passive mobilization versus controlled active motion. J Hand Surg Am 2014; 39 (07) 1344-1350
    CrossrefPubMedSuche in Google Scholar
  • 16 Chesney A, Chauhan A, Kattan A, Farrokhyar F, Thoma A. Systematic review of flexor tendon rehabilitation protocols in zone II of the hand. Plast Reconstr Surg 2011; 127 (04) 1583-1592
    CrossrefPubMedSuche in Google Scholar
  • 17 Galanakis I, Aligizakis A, Katonis P, Vavouranakis H, Stergiopoulos K, Hadjipavlou A. Functional evaluation after primary flexor tendon repair in zone II. Acta Orthop Belg 2003; 69 (03) 252-256
    PubMedSuche in Google Scholar
  • 18 Thien TB, Becker JH, Theis JC. Rehabilitation after surgery for flexor tendon injuries in the hand. Cochrane Database Syst Rev 2004; x (04) CD003979
    PubMedSuche in Google Scholar
  • 19 Singh J. Critical appraisal skills programme. J Pharmacol Pharmacother 2013; 4 (01) 76-77
    CrossrefSuche in Google Scholar
  • 20 Beaton DE, Davis AM, Hudak P, Mcconnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure: What do we know about it now?. Br J Hand Ther 2001; 6 (04) 109-118
    CrossrefSuche in Google Scholar
  • 21 Yen CH, Chan WL, Wong JW, Mak KH. Clinical results of early active mobilisation after flexor tendon repair. Hand Surg 2008; 13 (01) 45-50
    CrossrefPubMedSuche in Google Scholar
  • 22 Osada D, Fujita S, Tamai K, Yamaguchi T, Iwamoto A, Saotome K. Flexor tendon repair in zone II with 6-strand techniques and early active mobilization. J Hand Surg Am 2006; 31 (06) 987-992
    CrossrefPubMedSuche in Google Scholar
  • 23 Khan MK, Khurram MF, Khan AH, Habiba NU, Chowdhry M. Zone 2 flexor tendon injuries: our experience with early active movement protocol for rehabilitation of tendons. Ann Med Res 2019; 26 (10) 2110-2113
    CrossrefSuche in Google Scholar
  • 24 Trumble TE, Vedder NB, Seiler III JG, Hanel DP, Diao E, Pettrone S. Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy. J Bone Joint Surg Am 2010; 92 (06) 1381-1389
    CrossrefPubMedSuche in Google Scholar
  • 25 Peck FH, Bücher CA, Watson JS, Roe A. A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2. J Hand Surg [Br] 1998; 23 (01) 41-45
    CrossrefPubMedSuche in Google Scholar