Outcomes and rupture rate of the "Adelaide" four-strand repair for zone 2 flexor tendon injuries over a 10-year period

Background Multi-strand core suture techniques combined with early active mobilization regimens have demonstrated improved functional outcomes in zone II flexor tendon injuries. This study evaluated the integrity of the "Adelaide" four-strand repair and assessed its outcome on function. Methods All zone II flexor tendon repairs were identified from a prospectively collected database from 2002 to 2012. Patient demographics, number and type fingers injured, neurological deficits, length to surgery, and rupture rates were recorded. Strickland and Modified Strickland measurements assessed the functional outcome. Follow-up was for 12 weeks post-operatively. Results A total of 167 patients and 197 fingers were identified, of which 111 and 125 respectively had complete data for analysis. Patient demographics included 93 males and 18 females with a mean age of 28.6 years (15-68). The most common finger injured was index 41/125 (35%), 105/111 (95%) had surgery within 3 days, 69/125 (55%) had an associated digital nerve injury, and 44/111 (40%) were smokers. Strickland and Modified Strickland calculations demonstrated 92/125 (74%) patients had a good/excellent result, 25/125 (20%) fair, and 8/125 (6%) had a poor result. Rupture rate was 5/125 (4%). Conclusions The "Adelaide" repair combined with early active mobilization achieves a good functional outcome with low rupture rates. Level of evidence: Level III; therapeutic study