The assessment of flexor tendon function after primary tendon repair.

Because the actual methods of assessment and the grading of these methods in favor at any one time have changed so much over the last 50 years, the usefulness of the considerable experience in this field for practitioners today is much reduced. Agreement on the systems of assessment to be used for the different parts of the flexor system would allow a better exchange of knowledge worldwide at this time and a more useful cumulative experience for the next 50 years. If an acceptable method of assessment of any particular injury and its treatment can be agreed on by all, two stages remain for us to audit our work. The first is identifying how much we must downgrade the expectations of the assessment to accommodate the imperfections of our treatments. Most patients would consider an "excellent" result to be a return to normal. Currently, using, for example, the first Strickland system of assessment, we are happy to call any result of primary repair of a zone 2 flexor tendon division greater than 85% of normal, "excellent." How much we should reasonably downgrade our assessments is a variable that one hopes would reduce with accumulated experience, but one that makes repeated adjustment of our methods of assessment essential. Having set the level of the "excellent," "good," "fair," and "poor" qualifying bands relative to normal digital function, it only remains to take our measuring instruments out of their boxes and measure!