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The Journal of Bone and Joint Surgery (American) 84:78-84 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Effect of Synergistic Wrist Motion on Adhesion Formation After Repair of Partial Flexor Digitorum Profundus Tendon Lacerations in a Canine Model in Vivo

Chunfeng Zhao, MD, Peter C. Amadio, MD, Toshimitsu Momose, MD, Paulus Couvreur, MD, Mark E. Zobitz, MS and Kai-Nan An, PhD

Investigation performed at the Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Chunfeng Zhao, MD
Peter C. Amadio, MD
Toshimitsu Momose, MD
Paulus Couvreur, MD
Mark E. Zobitz, MS
Kai-Nan An, PhD
Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Arthritis and Musculoskeletal and Skin Diseases Grant AR 44391. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Therapy employing passive finger flexion and active finger extension with the wrist fixed in flexion is commonly used after flexor tendon repair. However, this method of rehabilitation may not produce full tendon excursion because of buckling of the tendon within its sheath with passive flexion. Studies of cadavera suggest that the use of synergistic wrist and finger motion may improve tendon gliding. The purpose of this study was to assess the effects of passive digital motion, performed with either wrist fixation or synergistic wrist motion, on adhesion and gap formation after flexor tendon repair.

Methods: Sixty-six dogs were randomly allocated to two groups. In each group, two flexor digitorum profundus tendons of one forepaw were partially (80%) lacerated and then repaired with a modified Kessler suture. In each group, a different postoperative therapy (wrist fixation or synergistic motion) was performed twice daily. The dogs were killed at one week, three weeks, or six weeks after surgery, and the repaired tendons were evaluated to determine the adhesion grade and adhesion breaking strength.

Results: The synergistic motion group had a significantly lower adhesion grade and significantly less adhesion breaking strength than the wrist fixation group at three and six weeks (p < 0.05). At one week, there was no significant difference between the two therapy groups (p > 0.05).

Conclusions: Passive digital flexion and extension with synergistic wrist motion was an effective therapy after repair of partial zone-2 lacerations in a canine model.


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