Skip to main content
SpringerLink
Log in

Evolution of Concepts in Flexor Tendon Surgery of the Hand

  • Chapter
Repair and Regeneration of Ligaments, Tendons, and Joint Capsule

Part of the book series: Orthopedic Biology and Medicine ((OBM))

  • 1590 Accesses

Abstract

Recovering function after a tendon injury to the hand continues to remain a challenge in clinical practice. Although suturing the two ends of a severed tendon may seem to be the most intuitive method today, tendon lacerations have been controversial for two centuries. Various researchers in both clinical and experimental fields have held contrasting views on all aspects of tendon injuries, from physiology of the normal tendon and its response to injury to the timing and technique of repair and subsequent mobilization. This chapter aims to present a historical timeline of evolving concepts of tendon surgery to provide insight into the parallel development of experimental research and surgical techniques that are behind the current fundamental principles of tendon surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Kleinert H, Kutz J, Ashbell TS, Martinez E. Primary repair of lacerated flexor tendons in “No Man’s Land” (abstract). J Bone Joint Surg 1967;49A:577.

    Google Scholar 

  2. Newmeyer III W, Manske P. No man’s land revisited: The primary flexor tendon repair controversy. J Hand Surg 2004;29A:1–5.

    Google Scholar 

  3. Gratz C. The history of tendon suture. Medical Journal and Record 1928;127:156–157, 213-215.

    Google Scholar 

  4. Adamson J, Wilson J. The history of flexor tendon grafting. J Bone Joint Surg 1961;43A:709–716.

    Google Scholar 

  5. Mayer L. The physiological method of tendon transplantation I. Historical, anatomy and physiology of tendons. Surg Gynaecol Obstet 1916;22:182–197.

    Google Scholar 

  6. Mayer L. The physiological method of tendon transplantation. II. Operative technique. Surg Gynaecol Obstet 1916;22:298–306.

    Google Scholar 

  7. Mayer L. The physiological method of tendon transplantation. III. Experimental and clinical experiences. Surg Gynaecol Obstet 1916;22:472–481.

    Google Scholar 

  8. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg. Gynaecol Obstet 1918;26:103–110.

    Google Scholar 

  9. Bunnell S. Repair of nerves and tendons of the hand. J Bone Joint Surg 1928;10:1–26.

    Google Scholar 

  10. Mason ML, Allen HS. The rate of healing of tendons. Ann Surg 1941;113:424–459.

    Article  PubMed  CAS  Google Scholar 

  11. Bunnell S. Primary repair of severed tendons. The use of stainless steel wire. Am J Surg 1940;47:502–516.

    Article  Google Scholar 

  12. Bunnell S. Surgery of the Hand. JB Lippincott, Philadelaphia, PA, 1944.

    Google Scholar 

  13. Koch SL. Division of the flexor tendons within the digital sheath. Surg Gynaecol Obstet 1943;78:9–22.

    Google Scholar 

  14. Boyes JH. Immediate vs delayed repair of the digital flexor tendons. Ann West Med Surg 1947;1:145–152.

    CAS  PubMed  Google Scholar 

  15. Littler JW. Free tendon grafts in secondary flexor tendon repair.” Am J Surg 1947;74:315–321.

    Article  CAS  PubMed  Google Scholar 

  16. Pulvertaft GR. Repair of tendon injuries in the hand. Ann Royal Coll Surg 1948;3:3–14.

    CAS  Google Scholar 

  17. Mason ML. Primary tendon repair. J Bone Joint Surg 1959;41A:575–577.

    Google Scholar 

  18. Boyes JH. Why tendon repair? J Bone Joint Surg 1959;41A:577–579.

    Google Scholar 

  19. Kelly AP. Primary Tendon Repairs. J Bone Joint Surg 1959;41A:581–598.

    Google Scholar 

  20. Allen HS. Management of lacerations of flexor tendons within the digits. Surg Clin North. Am 1955;35:189–194.

    Google Scholar 

  21. Siler VE. Primary tenorrhaphy of flexor tendons in the hand. J Bone Joint Surg 1950;32A:218–225.

    PubMed  CAS  Google Scholar 

  22. White WL. Secondary restoration of finger flexion by digital tendon grafts. Am J Surg 1956;91:662–668.

    Article  PubMed  CAS  Google Scholar 

  23. Verdan CE. Primary repair of flexor tendons. J Bone Joint Surg 1960;42A:647–657.

    Google Scholar 

  24. Kessler I, Nissim F. Primary repair without immobilization of flexor tendon division within the flexor sheath. Acta Orthop Scand 1969;40:587–601.

    PubMed  CAS  Google Scholar 

  25. Kleinert HE, Kutz JE, Ashbell TS, Martinez E. Primary repair of lacerated flexor tendons in “No Man’s Land” (abstract). J Bone Joint Surg 1967;49A:577.

    Google Scholar 

  26. Boyes JH. Discussion of Kleinert/Kutz/Ashbell/Martinez paper. J Bone Joint Surg 1967;49A:577.

    Google Scholar 

  27. Kleinert HE, Kutz JE, Atasoy E, Stormo A. Primary repair of flexor tendons. Orthop Clin. North Am 1973;4:865–876.

    PubMed  CAS  Google Scholar 

  28. Savage R, Risitano G. Flexor tendon repair using a “six strand” method of repair and early active mobilisation. J Hand Surg 1989;14B:396–399.

    Google Scholar 

  29. Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg 1989;14B:383–391.

    Google Scholar 

  30. Bainbridge LC, Robertson C, Gillies D, Elliot D. A comparison of postoperative mobilization of flexor tendon repairs with “passive flexion-active extension” and “controlled active motion” techniques. J Hand Surg 1994;19B:517–521.

    Google Scholar 

  31. Kitsis CK, Wade PJF, Krikler SJ, Parsons NK, Nicholls LK. Controlled active motion follwoing primary flexor tendon repair: A prospective study over 9 years. J Hand Surg 1998;23B:344–349.

    Google Scholar 

  32. Duran RJ, Houser RG. Controlled Passive Motion Following Flexor Tendon Repair in Zones II and III. CV Mosby, St. Louis, MO, 1975.

    Google Scholar 

  33. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone ll: A comparison of immobilization and controlled passive mobilization techniques. J Hand. Surg [Am] 1980;5:537–543.

    CAS  Google Scholar 

  34. Becker H. Primary repair of flexor tendons in the hand without immobilization’preliminary report. The Hand 1978;10:37–47.

    Article  PubMed  CAS  Google Scholar 

  35. Elliot D, Moiemen NS, Flemming AFS, Harris SB, Foster AJ. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg 1994;19B:607–612.

    Google Scholar 

  36. Strickland JW. Flexor tendon repair: Indiana method. The Indiana Hand Center Newsletter 1993;1:1–12.

    Google Scholar 

  37. Potenza AD. Tendon healing within the flexor digital sheath in the dog. J Bone Joint Surg 1962;44A:49–64.

    Google Scholar 

  38. Peacock EE. Biological principles in the healing of long tendons. Surg Clin North Am 1965;45:461–176.

    PubMed  CAS  Google Scholar 

  39. Potenza A. Critical evaluation of flexor tendon healing and adhesion formation within artificial digital sheaths. J Bone Joint Surg 1963;5A:1217–1233.

    Google Scholar 

  40. Manske PR. Flexor tendon healing. J Hand Surg 1988;13B:237–245.

    Google Scholar 

  41. Manske PR, Bridwell K, Whiteside LA, Lesker PA. Nutrition of flexor tendons in monkeys. Clin Orthop 1978;136:294–298.

    PubMed  Google Scholar 

  42. Lundborg G, Rand F. Experimental intrinsic healing of flexor tendons based upon synovial fluid nutrition. J Hand Surg 1978;3A:21–31.

    Google Scholar 

  43. Manske PR, Gelberman RH, Vande Berg JS, Lesker PA. Intrinsic flexor tendon repair. J. Bone Joint Surg 1984;66A:385–396.

    Google Scholar 

  44. Lindsay W, Thomson H. Digital flexor tendons: An experimental study. Part I. The significance of each component of the flexor mechanism in tendon healing. Br J Plast Surg 1960;12:289–316.

    Article  PubMed  CAS  Google Scholar 

  45. Chaplin D. The vascular anatomy within normal tendon, divided tendons, free tendon grafts and pedicle tendon grafts in rabbits. A microangiographic study. J Bone Joint Surg 1973;55B:369–389.

    Google Scholar 

  46. Gelberman RH, Khabie V, Cahill CJ. The revascularization of healing flexor tendons in the digital sheath. J Bone Joint Surg 1991;73A:868–881.

    Google Scholar 

  47. Garlock J. The repair process in wounds of tendons and in tendon grafts. Ann Surg 1927;85:92–103.

    PubMed  CAS  Google Scholar 

  48. Gelberman RH, Woo SL, Lothringer K, Akeson WH, Amiel D. Effects of early intermittent passive mobilization on healing canine flexor tendons. J Hand Surg [Am] 1982;7:170–175.

    CAS  Google Scholar 

  49. Gelberman RH, Amifl D, Gonsalves M, Woo S, Akeson WH. The influence of protected passive mobilization on the healing of flexor tendons: a biochemical and micro-angiographic study. Hand 1981;13:120–128.

    Article  PubMed  CAS  Google Scholar 

  50. Gelberman RH, Menon J, Gonsalves M, Akeson WH. The effects of mobilization on the vascularization of healing flexor tendons in dogs. Clin Orthop 1980;153:283–289.

    PubMed  Google Scholar 

  51. Gelberman RH, Vande Berg JS, Lundborg GN, Akeson WH. Flexor tendon healing and restoration of the gliding surface. J Bone Joint Surg 1983;65A:70–80.

    Google Scholar 

  52. Bunnell S. Reconstructive surgery of the hand. Surg Gynaecol Obstet 1924;39:259–274.

    Google Scholar 

  53. Bruner J. Incisions for plastic and reconstructive (non-septic)surgery of the hand. Br J. Plast Surg 1951;4:49–55.

    Article  Google Scholar 

  54. Bruner J. The zig-zag volar-digital incision for flexor-tendon surgery. Plast Reconst Surg 1967;40:571–574.

    Article  PubMed  CAS  Google Scholar 

  55. Tajima T. History, current status and aspects of hand surgery in Japan. Clin Orthop 1984;184:41–49.

    PubMed  Google Scholar 

  56. Lister GD, Kleinert HE, Kutz JE. Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg [Am] 1977;2:441–451.

    CAS  Google Scholar 

  57. Pennington D. The locking loop tendon suture. Plast Reconst Surg 1979;63:648–52.

    Article  PubMed  CAS  Google Scholar 

  58. Urbaniak J, Cahill JD, Mortensen RA. Tendon suturing methods: analysis of tensile strengths. In American Academy of Orthopaedic Surgeons: Symposium on Tendon Surgery. of the Hand. CV Mosby, St. Louis, MO, 1975, pp. 70–80.

    Google Scholar 

  59. Tsuge K, Ikuta Y, Matshuishi, Y. Intra-tendinous tendon suture in the hand. A new technique. Hand 1975;7:250–255.

    Article  PubMed  CAS  Google Scholar 

  60. Tsuge K, Ikuta Y, Matshuishi Y. Repair of flexor tendons by intratendinous suture. J Hand. Surg 1977;2:436–440.

    CAS  Google Scholar 

  61. Becker H. Primary repair of flexor tendons in the hand without immobilization: preliminary report. Hand 1978;10:37–47.

    Article  PubMed  CAS  Google Scholar 

  62. Savage R. In vitro studies of a new method of flexor tendon repair. J Hand Surg 1985;10B:135–141.

    Google Scholar 

  63. Wagner WF, Carroll IV C, Strickland JW, Heck DA, Toombs JP. A biomechanical comparison of techniques of flexor tendon repair. J Hand Surg 1994;19A:979–983.

    Google Scholar 

  64. Winters SC, Gelberman RH, Woo SL, Chan SS, Grewal R, Seiler JG III. The effects of multiple-strand suture methods on the strength and excursion of repaired intrasynovial flexor tendons: a biomechanical study in dogs. J Hand Surg 1988;23A:97–104.

    Google Scholar 

  65. Strickland JW. Biologic rationale, clinical application and results of early motion following flexor tendon repair. J Hand Ther 1989;2:71–83.

    Google Scholar 

  66. Strickland JW. Flexor tendon injuries: Foundations of treatment. J Am Acad Orthop Surg 1995;3:44–54.

    PubMed  Google Scholar 

  67. Hotokezaka S, Manske PR. Differences between locking loops and grasping loops: effects on 2-strand core suture. J Hand Surg 1997;22A:995–1003.

    Google Scholar 

  68. Hatanaka H, Manske PR. Effect of suture size on locking and grasping flexor tendon repair techniques. J Hand Surg 2000;24A:267–274.

    Google Scholar 

  69. Su B, Solomons M, Barrow A, Rosenwasser M. A randomized double blind clinical trial of Teno Fix; a novel device for tendon repair. Unpublished data 2003.

    Google Scholar 

  70. Kyle J, Eyre-Brook A. Flexor tendon injuries in the hand. Br J Surg 1954;41:502–511.

    Article  PubMed  CAS  Google Scholar 

  71. Wade PJF, Muir IFK, Hutcheon, LL. Primary flexor tendon repair: the mechanical limitations of the modified Kessler technique. J Hand Surg 1986;11B:71–76.

    Google Scholar 

  72. Pruitt DL, Manske PR, Fink B. Cyclic stress analysis of flexor tendon repair. J Hand Surg 1991;16A:701–707.

    Google Scholar 

  73. Lindsay WK, Thomson HG, Walker FG. Digital flexor tendons: and experimental study. Part II. The significance of gap occuring at the line of suture. Br J Plast Surg 1960;13:1–9.

    Article  Google Scholar 

  74. Seradge H. Elongation of the repair configuration following flexor tendon repair. J Hand. Surg 1983;8A:182–185.

    Google Scholar 

  75. Gelberman RH, Boyer MI, Brodt MD. The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons: an experimental study on the early stages of tendon healing in dogs. J Bone Joint Surg 1999;81A:1975–1982.

    Google Scholar 

  76. Lin GT, An KN, Amadio PC. Biomechanical studies of running suture for flexor tendon repair in dogs. J Hand Surg 1988;13A:553–558.

    Google Scholar 

  77. Wade PJF, Wetherell RG, Amis AA. Flexor tendon repair: Significant gain in strength from the Halstead peripheral suture technique. J Hand Surg 1989;14B:232–235.

    Google Scholar 

  78. Silfverskiold KL, Andersson CH. Two new methods of tendon repair: An in vitro evaluation of tensile strength and gap formation. J Hand Surg 1993;18A:58–65.

    Google Scholar 

  79. Strickland JW. Development of flexor tendon surgery: twenty-five years of progress. J. Hand Surg 2000 25A:214–229.

    Google Scholar 

  80. Barrie KA, Wolfe SW, Shean C, Shenbagamurthi D, Slade III JF, Panjabi MM. A biomechanical comparison of multistrand flexor tendon repairs using an in situ testing model. J. Hand Surg 2000;25A:499–506.

    Google Scholar 

  81. Iselin M. “Delayed emergencies” in fresh wounds of the hand. Proc Royal Soc Med 1958;51:713–714.

    CAS  Google Scholar 

  82. Madsen E. “Delayed emergency” treatment of open lesions of the extremities. Acta Orthop. Scand 1963;33:380.

    Google Scholar 

  83. Madsen E. Delayed primary suture of flexor tendons cut in the digital sheath. J Bone Joint. Surg 1970;52B:264–267.

    Google Scholar 

  84. Schneider LH, Hunter JM, Norris TR, Nadeau PO. Delayed flexor tendon repair in no man’s land. J Hand Surg [Am] 1977;2:452–455.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Hand and Upper Extremity Surgery, Orthopaedic Surgery Department, University of Arkansas for Medical Sciences, Little Rock, AR

    Randip R. Bindra MD, FRCS

Authors
  1. Randip R. Bindra MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Orthopaedic Research Laboratory, University of New South Wales Sydney, Australia

    William R. Walsh PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Bindra, R.R. (2006). Evolution of Concepts in Flexor Tendon Surgery of the Hand. In: Walsh, W.R. (eds) Repair and Regeneration of Ligaments, Tendons, and Joint Capsule. Orthopedic Biology and Medicine. Humana Press. https://doi.org/10.1385/1-59259-942-7:087

Download citation

  • DOI: https://doi.org/10.1385/1-59259-942-7:087

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-174-5

  • Online ISBN: 978-1-59259-942-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation