Flexor Tendon Injuries: I. Foundations of Treatment.

During the past 20 years, the difficult process of reestablishing satisfactory function after primary repair of flexor tendons has evolved from scientifically unsupported trial-and-error efforts to protocols based on sound laboratory and clinical investigations. Enhanced appreciation of tendon structure, nutrition, and biomechanical properties and investigation of factors involved in tendon healing and adhesion formation have had significant clinical applications. In particular, it has been found that repaired tendons subjected to early motion stress will increase in strength more rapidly and develop fewer adhesions than immobilized repairs. As a result, new and stronger tendon repair techniques have evolved, permitting the application of early passive and even light active forces. The author reviews the most recent and clinically pertinent research in flexor tendon surgery and discusses repair techniques and rehabilitation protocols based on the information provided by these studies.