Preliminary results with the Kessler-Tsuge knotless technique to Zone II Flexor Tendon lacerations: – a case series study
DOI:
https://doi.org/10.25214/28056272.1648Keywords:
Tendon Injuries, Suture Techniques, TendonsAbstract
Introduction : Flexor tendon injuries have an annual incidence of 33 x 100,000. Zone II lacerations account for the
most difficult to repair. There is no true consensus regarding a technique or the best suture material to be used. A strong
suture with a high tensile strength avoiding avascularity changes, provide the ability to expedite the rehabilitation
protocols. The goal of this study is to evaluate the results of the Kessler-Tsuge knotless technique.
Methods: Thirty patients with Zone II flexor tendon lacerations were included from 2017 to 2020 in this prospective
multicenter series of cases study. The Kessler-Tsuge knotless repair technique with 4-0 FiberLoop was used on all the
tendon lacerations.
Results: A total of 30 surgical procedures were performed with the described technique. Sixteen patients were lost
to final follow-up. The average age was 26 with a median of 20. The small and ring fingers were the most commonly
injured (57% and 35% respectively). Duran’s flexor tendon rehabilitation protocol was used. At the first month, the average
range of motion (ROM) was 65° PIP and 43° for the DIP joint and ROM of 92° PIP and 72.5° DIP joint at 3 third
month. The Visual Analogue Scale (VAS) for pain was 2 at 3 months. There were no any re-ruptures at final follow-up.
Discussion: kessler-Tsuge technique is a safe and reproducible technique that allows for a hidden knot at the A2
pulley level with a configuration of 4 core strands in two passes. Furthermore, it does not cause shortening of the
ends, provides a homogeneous and smooth bed for tendon gliding, allows for an expedite post-operative protocol, and
displayed good functional results at 3 months post- operative.
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