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J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(4):544-547.

Comparison Of Outcome Of 1- And 2-Knot, 4-Strand, Doublemodified Kessler Flexor Tendon Repair With Early Active Mobilization Protocol In Patients With Flexor Tendon Lacerations Of Hand.

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Jinnah Burn and Reconstructive Surgery Centre Lahore, Pakistan.



Hand is unique for the dexterity of its function and flexor tendons have most important function in hand. Its injury is a challenging treatment. Purpose of this study is to compare the success of 1- and 2-knot, flexor tendon repair (good to excellent results) with early active mobilization in terms of total active motion (TAM) of affected hand postoperatively.


Hundred patients with age range of 5-70 years of age presenting with flexor tendon lacerations of hand were included in the study. Subjects were randomly divided into Group A, who underwent flexor tendon repair using 4 strands of double modified Kessler repair with 1 knot and Group B, in which 4 strand double modified Kessler repair with 2 knot technique was used. All patients followed early active motion protocol started in first 48 hours. They were followed at 3, 6 and 8 weeks after surgery for TAM. Data was entered and analysed in SPSS-21.0. Frequency and percentages were calculated for outcome of procedure.


In group A 89.8% (44) of patients had good to excellent results in terms of total active motion (TAM) as compared with 90.9% (40) in group B using early active mobilization protocol.


The study concluded that that four strand double modified flexor tendon repair using either 1 or 2 knot technique are excellent choices of repair with early active mobilization protocols.


4 strand repair; Flexor tendon injuries;; Total active motion; Early active mobilization

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