Instructional Course Lecture   |    
Flexor Tendon Repair and Rehabilitation State of the Art in 2002
Martin I. Boyer, MD, FRCS(C); James W. Strickland, MD; Drew R. Engles, MD; Kavi Sachar, MD; Fraser J. Leversedge, MD
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

Martin I. Boyer, MD, FRCS(C)
Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, One Barnes Plaza, Suite 11300, St. Louis, MO 63110. E-mail address: boyerm@msnotes.wustl.edu

James W. Strickland, MD
755 West Carmel Drive, Suite 202, Carmel, IN 46082-3430

Drew R. Engles, MD
Summit Hand Center, 3975 Embassy Parkway, Suite 201, Akron, OH 44333

Kavi Sachar, MD
Fraser J. Leversedge, MD
Hand Surgery Associates, 2535 South Downing Street, Suite 500, Denver, CO 80210
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from National Institutes of Health (AR 33097). 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.

Printed with the permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2003 in Instructional Course Lectures, Volume 52. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

J Bone Joint Surg Am, 2002 Sep 01;84(9):1684-1706
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Major advances in the understanding of intrasynovial flexor tendon repair and rehabilitation have been made since the early 1970s 1,2 , when reports first demonstrated that flexor tendon lacerations within the fibro-osseous digital sheath could be repaired primarily, and rehabilitation could be successful, without tendon excision and delayed grafting 3 . The concept of adhesion-free, or intrinsic, tendon-healing-namely, the idea that tendons could heal primarily without the ingrowth of fibrous adhesions from the surrounding sheath�has been validated both experimentally and clinically in studies over the past twenty years 4-13 . Recent attempts to understand and improve the results of intrasynovial flexor tendon repair have focused on restoration of the gliding surface 11,14-23 , on the biomechanics at the repair site 24-36 , and on the molecular biology of early tendon healing 37-47 . The goals of the surgical treatment of intrasynovial flexor tendon lacerations have remained unchanged: they include achievement of a primary tendon repair of sufficient tensile strength to allow application of a postoperative passive-motion rehabilitation protocol that inhibits formation of intrasynovial adhesions, stimulates restoration of the gliding surface, and facilitates healing of the repair site 48 .
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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