LONG-TERM FOLLOW-UP AFTER PRIMARY REPAIR OF 20 ISOLATED FLEXOR POLLICIS LONGUS TENDON LACERATIONS

Purpose of the study This study was performed to assess the long term functional result oi Flexor Pollicis Longus tendon repair, with a spec ial interest to the influence of associated neurovascular damages. sur gical procedures and rehabilitation techniques. Material 20 out 30 pat ients operated between 1979 and 1994 returned for follow-up (average 5 .3 years), The 10 patients lost for follow-up presented no significant epidemiological difference. The location of the laceration was classi fied according to the International Federation of Hand Surgery Societi es (10 T1, 6 T2, 1 T3, 2 T4, T5), and a 3 staged classification of neu rovascular bundles damage was used. Methods A quantitative evaluation of the active range of motion (extension and flexion) of the interphal angeal joint (IP) was used and allowed calculation of the Tubiana's ra ting score, The pollici-digital key-pinch was assessed both qualitativ ely and quantitatively. All the data were compared with the opposite t humb. Results 85 per cent of patients had excellent or good results ac cording to Tubiana's rating score. The mean flexion of the IP joint wa s 49.7 degrees (64 per cent of the apposite side), and the key-pinch s trength was 69 per cent of its contralateral value. On the opposite, t he mean extension was 0.75 degrees and 3 patients complained about poo r quality of their lateral key-pinch. Discussion A quantitative evalua tion is more meaningfull than a global rating core, especially for IP joint lack of extension, and could lead to underestimate the actual pa tient discomfort, Despite the absence of statistical relevance, lacera tions of the 2 neurovascular bundles (stage III) seem to impair the fi nal result. We have found no difference between different types uf ten don sutures, A protected post-operative passive rehabilition seemed to Improve both motion and strength of the operated thumb. Conclusion Th ere is no more discussion about the need to repair in emergency all th e damaged structures of the thumb. We recommend wrist tendon lengtheni ng when a pull-out suture is used, and when there is an impingement be tween suture and pulleys in T2 zone. We prefer a controlled-passive re habilitation.