Journal of Hand Therapy
Volume 18, Issue 2 , Pages 157-168 , April 2005

The Evolution of Early Mobilization of the Repaired Flexor Tendon

  • Karen M. Pettengill, MS, OTR/L, CHT

      Affiliations

    • Corresponding Author InformationCorrespondence and reprint requests to Karen M. Pettengill, 25 Raingley Road, Greenfield, MA 01301

References 

  1. Hitchcock TF, Light TR, Bunch WH, et al. The effect of immediate constrained digital motion on the strength of flexor tendon repairs in chickens. J Hand Surg [Am]. 1987;12:590–595
  2. Tottenham VM, Wilton-Bennett K, Jeffrey J. Effects of delayed therapeutic intervention following zone II flexor tendon repair. J Hand Ther. 1995;8:23–26
  3. Halikis MN, Manske PR, Kubota H, et al. Effect of immobilization, immediate mobilization, and delayed mobilization on the resistance to digital flexion using a tendon injury model. J Hand Surg [Am]. 1997;22:464–472
  4. Zhao C, Amadio PC, Paillard P, et al. Digital resistance and tendon strength during the first week after flexor digitorum profundus tendon repair in a canine model in vivo. J Bone Joint Surg Am. 2004;86:320–327
  5. Allen BN, Frykman GK, Unsell RS, et al. Ruptured flexor tendon tenorrhaphies in zone II: repair and rehabilitation. J Hand Surg [Am]. 1987;12:18–21
  6. Bainbridge LC, Robertson C, Gillies D, et al. A comparison of post-operative mobilization of flexor tendon repairs with “passive flexion-active extension” and “controlled active motion” techniques. J Hand Surg [Br]. 1994;19:517–521
  7. Cannon N. Post flexor tendon repair motion protocol. Indiana Hand Center Newsletter. 1993;1:13–18
  8. Cullen KW, Tolhurst P, Lang D, et al. Flexor tendon repair in zone 2 followed by controlled active mobilisation. J Hand Surg [Br]. 1989;14:392–395
  9. Elliot D, Moiemen NS, Flemming AF, et al. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg [Br]. 1994;19:607–612
  10. Evans RB, Thompson DE. The application of force to the healing tendon. J Hand Ther. 1993;6:266–284
  11. Kitsis CK, Wade PJ, Krikler SJ, et al. Controlled active motion following primary flexor tendon repair: a prospective study over 9 years. J Hand Surg [Br]. 1998;23:344–349
  12. Silfverskiold KL, May EJ. Early active mobilization after tendon transfers using mesh reinforced suture techniques. J Hand Surg [Br]. 1995;20:291–300
  13. Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg [Br]. 1989;14:383–391
  14. Klein L. Early active motion flexor tendon protocol using one splint. J Hand Ther. 2003;16:199–206
  15. Steelman P. Treatment of flexor tendon injuries: therapist's commentary. J Hand Ther. 1999;12:149–151
  16. Gratton P. Early active mobilization after flexor tendon repairs. J Hand Ther. 1993;6:285–289
  17. Harmer TW. Tendon suture. Boston Med Surg J. 1917;177:808
  18. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet. 1918;26:103–110
  19. Kessler I, Nissim F. Primary repair without immobilization of flexor tendon division within the digital sheath. An experimental and clinical study. Acta Orthop Scand. 1969;40:587–601
  20. Kleinert HE, Kutz JE, Ashbell S, et al. Primary repair of lacerated flexor tendons in no-man's-land. J Bone Joint Surg Am. 1967;49:577
  21. Verdan C. Practical considerations for primary and secondary repair in flexor tendon injuries. Surg Clin North Am. 1964;44:951–970
  22. Verdan CE. Primary repair of flexor tendons. Am J Orthop. 1960;42:647–657
  23. Kleinert HE, Kutz JE, Atasoy E, et al. Primary repair of flexor tendons. Orthop Clin North Am. 1973;4:865–876
  24. Kleinert HE, Kutz JE, Cohen MJ. Primary repair of zone 2 flexor tendon lacerations. In: AAOS Symposium on Tendon Surgery in the Hand. St. Louis: C.V. Mosby; 1975;p. 91–104
  25. Duran R, Houser R. Controlled passive motion following flexor tendon repair in zones 2 and 3. In: AAOS Symposium on Tendon Surgery in the Hand. St. Louis: C.V. Mosby; 1975;p. 105–114
  26. Lister GD, Kleinert HE, Kutz JE, et al. Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg [Am]. 1977;2:441–451
  27. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in zone 2: a comparison study of immobilization and controlled passive motion. J Hand Surg [Am]. 1980;5:537–543
  28. Gelberman RH, Amiel D, Gonsalves M, et al. The influence of protected passive mobilization on the healing of flexor tendons: a biochemical and microangiographic study. Hand. 1981;13:120–128
  29. Gelberman RH, Manske PR. Factors influencing flexor tendon adhesions. Hand Clin. 1985;1:35–42
  30. Gelberman RH, Manske PR, Akeson WH, et al. Flexor tendon repair. J Orthop Res. 1986;4:119–128
  31. Gelberman RH, Manske PR, Vande Berg JS, et al. Flexor tendon repair in vitro: a comparative histologic study of the rabbit, chicken, dog, and monkey. J Orthop Res. 1984;2:39–48
  32. Gelberman RH, Menon J, Gonsalves M, et al. The effects of mobilization on the vascularization of healing flexor tendons in dogs. Clin Orthop Rel Res. 1980;153:283–289
  33. Gelberman RH, Vande Berg JS, Lundborg GN, et al. Flexor tendon healing and restoration of the gliding surface. An ultrastructural study in dogs. J Bone Joint Surg Am. 1983;65:70–80
  34. Gelberman RH, Woo SL, Lothringer K, et al. Effects of early intermittent passive mobilization on healing canine flexor tendons. J Hand Surg [Am]. 1982;7:170–175
  35. Lundborg G. Experimental flexor tendon healing without adhesion formation: a new concept of tendon nutrition and intrinsic healing mechanisms. A preliminary report. Hand. 1976;8:235–238
  36. Lundborg G, Holm S, Myrhage R. The role of synovial fluid and tendon sheath for flexor tendon nutrition. Scand J Plast Reconstr Surg Hand Surg. 1980;14:99–107
  37. Lundborg G, Rank F. Experimental intrinsic healing of flexor tendons based upon synovial fluid nutrition. J Hand Surg. 1978;3:21–31
  38. Manske P, Bridwell K, Whiteside L, et al. Nutrition of flexor tendons in monkeys. Clin Orthop Rel Res. 1978;136:294–298
  39. Manske PR. The flexor tendon. Orthopedics. 1987;10:1733–1741
  40. Manske PR. Flexor tendon healing. J Hand Surg [Br]. 1988;13:237–245
  41. Manske PR, Bridwell K, Lesker PA. Nutrient pathways to flexor tendons of chickens using tritiated proline. J Hand Surg [Am]. 1978;3:352–357
  42. Manske PR, Gelberman RH, Lesker PA. Flexor tendon healing. Hand Clin. 1985;1:25–34
  43. Manske PR, Lesker PA. Nutrient pathways of flexor tendons in primates. J Hand Surg [Am]. 1982;7:436–444
  44. Manske PR, Lesker PA. Histologic evidence of intrinsic flexor tendon repair in various experimental animals. An in vitro study. Clin Orthop. 1984;297–304
  45. Manske PR, Lesker PA. Flexor tendon nutrition. Hand Clin. 1985;1:13–24
  46. Manske PR, Lesker PA. Diffusion as a nutrient pathway to the flexor tendon. In:  Hunter JM,  Schneider LH,  Mackin EJ editor. Tendon Surgery in the Hand. St. Louis: C.V. Mosby; 1987;p. 86–90
  47. Manske PR, Lesker PA, Gelberman RH, et al. Intrinsic restoration of the flexor tendon surface in the nonhuman primate. J Hand Surg [Am]. 1985;10:632–637
  48. Matthews P. The fate of isolated segments of flexor tendons within the digital sheath–a study in synovial nutrition. Br J Plast Surg. 1976;29:216–224
  49. Matthews P, Richards H. The repair potential of digital flexor tendons. An experimental study. J Bone Joint Surg Br. 1974;56:618–625
  50. Matthews P, Richards H. Factors in the adherence of flexor tendons after repair. An experimental study in the rabbit. J Bone Joint Surg Br. 1976;58:230–236
  51. Richards HJ. Repair and healing of the divided digital flexor tendon. Injury. 1980;12:1–12
  52. Woo SL, Gelberman RH, Cobb NG, et al. The importance of controlled passive mobilization on flexor tendon healing. A biomechanical study. Acta Orthop Scand. 1981;52:615–622
  53. Woo SL, Gomez MA, Woo YK, et al. Mechanical properties of tendons and ligaments. II. The relationships of immobilization and exercise on tissue remodeling. Biorheology. 1982;19:397–408
  54. Citron ND, Forster A. Dynamic splinting following flexor tendon repair. J Hand Surg [Br]. 1987;12:96–100
  55. van Alphen JC, Oepkes CT, Bos KE. Activity of the extrinsic finger flexors during mobilization in the Kleinert splint. J Hand Surg [Am]. 1996;21:77–84
  56. Horii E, Lin GT, Cooney WP, et al. Comparative flexor tendon excursion after passive mobilization: an in vitro study. J Hand Surg [Am]. 1992;17:559–566
  57. Groth GN, Loeding LA, Young VL. Early active mobilization of flexor tendon repairs utilizing the double loop locking suture technique. Presented at the annual meeting of the American Society of Hand Therapists, Orlando, Florida, 1991.
  58. Sandow MJ, McMahon MM. Single-cross grasp six-strand repair for acute flexor tenorrhaphy: modified Savage technique. Atlas Hand Clin. 1996;1:41–64
  59. Pettengill KMS, Strien GV. Postoperative management of flexor tendon injuries. In:  Mackin EJ,  Callahan AD,  Skirven TM, et al. editor. 5th ed.. Rehabilitation of the Hand and Upper Extremity. vol 1:Mosby; 2002;p. 431–456
  60. Urbaniak JR, Cahill JD, Mortenson RA. Tendon suturing methods: analysis of tensile strengths. In: AAOS Symposium on Tendon Surgery in the Hand. St. Louis: C.V. Mosby; 1975;p. 70–80
  61. Savage R. In vitro studies of a new method of flexor tendon repair. J Hand Surg [Br]. 1985;10:135–141
  62. Silfverskiold KL, Andersson CH. Two new methods of tendon repair: an in vitro evaluation of tensile strength and gap formation. J Hand Surg [Am]. 1993;18:58–65
  63. Strickland J. Flexor tendon repair: Indiana method. Indiana Hand Center Newsletter. 1993;1:1–12
  64. Strickland JW. Flexor Tendon Injuries: II. Operative Technique. J Am Acad Orthop Surg. 1995;3:55–62
  65. Diao E, Hariharan JS, Soejima O, et al. Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg [Am]. 1996;21:234–239
  66. Mashadi ZB, Amis AA. Strength of the suture in the epitenon and within the tendon fibres: development of stronger peripheral suture technique. J Hand Surg [Br]. 1992;17:172–175
  67. Pruitt DL, Manske PR, Fink B. Cyclic stress analysis of flexor tendon repair. J Hand Surg [Am]. 1991;16:701–707
  68. Pruitt DL, Tanaka H, Aoki M, et al. Cyclic stress testing after in vivo healing of canine flexor tendon lacerations. J Hand Surg [Am]. 1996;21:974–977
  69. Silfverskiold KL, May EJ. Gap formation after flexor tendon repair in zone II. Results with a new controlled motion programme. Scand J Plast Reconstr Surg Hand Surg. 1993;27:263–268
  70. Silfverskiold KL, May EJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg [Am]. 1994;19:53–60
  71. Silfverskiold KL, May EJ, Tornvall AH. Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg [Am]. 1992;17:539–546
  72. Wade PJ, Wetherell RG, Amis AA. Flexor tendon repair: significant gain in strength from the Halsted peripheral suture technique. J Hand Surg [Br]. 1989;14:232–235
  73. Williams RJ, Amis AA. A new type of flexor tendon repair. Biomechanical evaluation by cyclic loading, ultimate strength and assessment of pulley friction in vitro. J Hand Surg [Br]. 1995;20:578–583
  74. Angeles JG, Heminger H, Mass DP. Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations. J Hand Surg [Am]. 2002;27:508–517
  75. Aoki M, Manske PR, Pruitt DL, et al. Work of flexion after flexor tendon repair according to the placement of sutures. Clin Orthop. 1995;205–210
  76. Aoki M, Manske PR, Pruitt DL, et al. Work of flexion after tendon repair with various suture methods. A human cadaveric study. J Hand Surg [Br]. 1995;20:310–313
  77. Aoki M, Ito K, Wada T, et al. Mechanical characteristics of cross-stitch epitenon suture in association with various two-strand core sutures: a biomechanical study using canine cadaver tendons. Injury. 1996;27:703–707
  78. Barrie KA, Tomak SL, Cholewicki J, et al. The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading. J Hand Surg [Am]. 2000;25:714–720
  79. Barrie KA, Wolfe SW. The relationship of suture design to biomechanical strength of flexor tendon repairs. Hand Surg. 2001;6:89–97
  80. Dona E, Turner AW, Gianoutsos MP, et al. Biomechanical properties of four circumferential flexor tendon suture techniques. J Hand Surg [Am]. 2003;28:824–831
  81. Kim PT, Aoki M, Tokita F, et al. Tensile strength of cross-stitch epitenon suture. J Hand Surg [Br]. 1996;21:821–823
  82. Kubota H, Aoki M, Pruitt DL, et al. Mechanical properties of various circumferential tendon suture techniques. J Hand Surg [Br]. 1996;21:474–480
  83. Lee H. Double loop locking suture: a technique of tendon repair for early active mobilization. Part II. J Hand Surg [Am]. 1990;15:953–958
  84. Lee H. Double loop locking suture: a technique of tendon repair for early active mobilization. Part I. J Hand Surg [Am]. 1990;15:945–952
  85. Merrell GA, Wolfe SW, Kacena WJ, et al. The effect of increased peripheral suture purchase on the strength of flexor tendon repairs. J Hand Surg [Am]. 2003;28:464–468
  86. Noguchi M, Seiler JG, Gelberman RH, et al. In vitro biomechanical analysis of suture methods for flexor tendon repair. J Orthop Res. 1993;11:603–611
  87. Olivier LC, Assenmacher S, Kendoff D, et al. Results of flexor tendon repair of the hand by the motion-stable wire suture by Towfigh. Arch Orthop Trauma Surg. 2001;121:212–218
  88. Pruitt DL, Aoki M, Manske PR. Effect of suture knot location on tensile strength after flexor tendon repair. J Hand Surg [Am]. 1996;21:969–973
  89. Robertson GA, Al-Quattan MM. A biomechanical analysis of a new interlock suture technique for flexor tendon repair. J Hand Surg [Br]. 1992;17:92–93
  90. Taras JS, Raphael JS, Marczyk SC, et al. Evaluation of suture caliber in flexor tendon repair. J Hand Surg [Am]. 2001;26:1100–1104
  91. Trail IA, Powell ES, Noble J. The mechanical strength of various suture techniques. J Hand Surg [Br]. 1992;17:89–91
  92. Zhao C, Amadio PC, Momose T, et al. The effect of suture technique on adhesion formation after flexor tendon repair for partial lacerations in a canine model. J Trauma. 2001;51:917–921
  93. Zobitz ME, Zhao C, Erhard L, et al. Tensile properties of suture methods for repair of partially lacerated human flexor tendon in vitro. J Hand Surg [Am]. 2001;26:821–827
  94. Greenwald D, Shumway S, Allen C, et al. Dynamic analysis of profundus tendon function. J Hand Surg [Am]. 1994;19:626–635
  95. Schuind F, Garcia-Elias M, Cooney WP, et al. Flexor tendon forces: in vivo measurements. J Hand Surg [Am]. 1992;17:291–298
  96. Powell ES, Trail IA. Forces transmitted along human flexor tendons during passive and active movements of the fingers. J Hand Surg [Br]. 2004;29:386–389
  97. Strickland JW. Flexor tendon injuries: I. Foundations of treatment. J Am Acad Orthop Surg. 1995;3:44–54
  98. Zatsiorsky VM, Li ZM, Latash ML. Enslaving effects in multi-finger force production. Exp Brain Res. 2000;131:187–195
  99. Lieber RL, Amiel D, Kaufman KR, et al. Relationship between joint motion and flexor tendon force in the canine forelimb. J Hand Surg [Am]. 1996;21:957–962
  100. May EJ, Silfverskiold KL, Sollerman CJ. Controlled mobilization after flexor tendon repair in zone II: a prospective comparison of three methods. J Hand Surg [Am]. 1992;17:942–952
  101. Burge PD, Brown M. Elastic band mobilisation after flexor tendon repair; splint design and risk of flexion contracture. J Hand Surg [Br]. 1990;15:443–448
  102. Chow J, Stephens M, Ngai W, et al. A splint for controlled active motion after flexor tendon repair: design, mechanical testing and preliminary clinical results. J Hand Surg [Am]. 1990;15A:645–651
  103. Werntz J, Chesher S, Breidenbach W, et al. A new dynamic splint for postoperative treatment of flexor tendon injury. J Hand Surg [Am]. 1989;14:559–566
  104. Becker H, Hardy M. A constant tension dynamic splint. Plast Reconstr Surg. 1980;66:148–150
  105. McGrouther DA, Ahmed M. Flexor tendon excursions in “no man's land.”. Hand. 1981;13:129–141
  106. Elliot D. Primary flexor tendon repair–operative repair, pulley management and rehabilitation. J Hand Surg [Br]. 2002;27:507–513
  107. Horibe S, Woo SL, Spiegelman JJ, et al. Excursion of the flexor digitorum profundus tendon: a kinematic study of the human and canine digits. J Orthop Res. 1990;8:167–174
  108. Tang JB, Cao Y, Xie RG. Effects of tension direction on strength of tendon repair. J Hand Surg [Am]. 2001;26:1105–1110
  109. Tang JB, Xu Y, Wang B. Repair strength of tendons of varying gliding curvature: a study in a curvilinear model. J Hand Surg [Am]. 2003;28:243–249
  110. Savage R. The influence of wrist position on the minimum force required for active movement of the interphalangeal joints. J Hand Surg [Br]. 1988;13:262–268
  111. Chow JA, Thomes LJ, Dovelle S, et al. A combined regimen of controlled motion following flexor tendon repair in “no man's land.”. Plast Reconstr Surg. 1987;79:447–455
  112. Chow JA, Thomes LJ, Dovelle S, et al. Controlled motion rehabilitation after flexor tendon repair and grafting. A multi-centre study. J Bone Joint Surg Br. 1988;70:591–595
  113. Cooney WP, Lin GT, An K-N. Improved tendon excursion following flexor tendon repair. J Hand Ther. 1989;2:102–106
  114. Dovelle S, Heeter P. The Washington regimen: rehabilitation of the hand following flexor tendon injuries. Phys Ther. 1989;69:1034–1040
  115. Lopez MS, Hanley KF. Splint modification for flexor tendon repairs. Am J Occup Ther. 1984;38:398–403
  116. Slattery PG, McGrouther DA. A modified Kleinert Controlled Mobilization Splint following flexor tendon repair. J Hand Surg [Br]. 1984;9:217–218
  117. Silfverskiold KL, May EJ, Tornvall AH. Flexor digitorum profundus tendon excursions during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg [Am]. 1992;17:122–131
  118. Silfverskiold KL, May EJ, Tornvall AH. Tendon excursions after flexor tendon repair in zone. II: Results with a new controlled-motion program. J Hand Surg [Am]. 1993;18:403–410
  119. Tanaka T, Amadio PC, Zhao C, et al. Gliding resistance versus work of flexion–two methods to assess flexor tendon repair. J Orthop Res. 2003;21:813–818
  120. Tanaka T, Amadio PC, Zhao C, et al. Gliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model(1). J Hand Surg [Am]. 2004;29:6–14
  121. Zhao C, Amadio PC, Zobitz ME, et al. Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons. J Orthop Res. 2001;19:580–586
  122. Walbeehm ET, McGrouther DA. An anatomical study of the mechanical interactions of flexor digitorum superficialis and profundus and the flexor tendon sheath in zone 2. J Hand Surg [Br]. 1995;20:269–280
  123. Zhao CF, Amadio PC, Berglund L, et al. The A3 pulley. J Hand Surg [Am]. 2000;25:270–276
  124. Zhao C, Amadio PC, Zobitz ME, et al. Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro. J Hand Surg [Am]. 2002;27:316–321
  125. Tang JB. The double sheath system and tendon gliding in zone 2C. J Hand Surg [Br]. 1995;20:281–285
  126. Tang JB, Wang YH, Gu YT, et al. Effect of pulley integrity on excursions and work of flexion in healing flexor tendons. J Hand Surg [Am]. 2001;26:347–353
  127. Tang JB, Xie RG. Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing. J Hand Surg [Am]. 2001;26:855–861
  128. Tang JB, Xu Y, Chen F. Impact of flexor digitorum superficialis on gliding function of the flexor digitorum profundus according to regions in zone II. J Hand Surg [Am]. 2003;28:838–844
  129. Ejeskar A, Irstam L. Elongation in profundus tendon repair. A clinical and radiological study. Scand J Plast Reconstr Surg. 1981;15:61–68
  130. Gelberman RH, Boyer MI, Brodt MD, et al. The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. An experimental study on the early stages of tendon-healing in dogs. J Bone Joint Surg Am. 1999;81:975–982
  131. Hagberg L, Selvik G. Tendon excursion and dehiscence during early controlled mobilization after flexor tendon repair in zone II: an x-ray stereophotogrammetric analysis. J Hand Surg [Am]. 1991;16:669–680
  132. Ketchum LD. Primary tendon healing: a review. J Hand Surg [Am]. 1977;2:428–435
  133. Seradge H. Elongation of the repair configuration following flexor tendon repair. J Hand Surg [Am]. 1983;8:182–185
  134. Kubota H, Manske PR, Aoki M, et al. Effect of motion and tension on injured flexor tendons in chickens. J Hand Surg [Am]. 1996;21:456–463
  135. Zhao C, Amadio PC, Momose T, et al. Effect of synergistic wrist motion on adhesion formation after repair of partial flexor digitorum profundus tendon lacerations in a canine model in vivo. J Bone Joint Surg Am. 2002;84:78–84
  136. Zhao C, Amadio PC, Momose T, et al. Remodeling of the gliding surface after flexor tendon repair in a canine model in vivo. J Orthop Res. 2002;20:857–862
  137. Silva MJ, Brodt MD, Boyer MI, et al. Effects of increased in vivo excursion on digital range of motion and tendon strength following flexor tendon repair. J Orthop Res. 1999;17:777–783
  138. Lieber RL, Silva MJ, Amiel D, et al. Wrist and digital joint motion produce unique flexor tendon force and excursion in the canine forelimb. J Biomech. 1999;32:175–181
  139. Silva MJ, Boyer MI, Gelberman RH. Recent progress in flexor tendon healing. J Orthop Sci. 2002;7:508–514
  140. Boyer MI, Gelberman RH, Burns ME, et al. Intrasynovial flexor tendon repair. An experimental study comparing low and high levels of in vivo force during rehabilitation in canines. J Bone Joint Surg Am. 2001;83:891–899
  141. Goldfarb CA, Harwood F, Silva MJ, et al. The effect of variations in applied rehabilitation force on collagen concentration and maturation at the intrasynovial flexor tendon repair site. J Hand Surg [Am]. 2001;26:841–846
  142. Ditsios KT, Burns ME, Boyer MI, et al. The rigidity of repaired flexor tendons increases following ex vivo cyclic loading. J Biomech. 2002;35:853–856
  143. Zhao C, Amadio PC, Zobitz ME, et al. Effect of synergistic motion on flexor digitorum profundus tendon excursion. Clin Orthop. 2002;223–230

PII: S0894-1130(05)00034-7

doi: 10.1197/j.jht.2005.01.007

Journal of Hand Therapy
Volume 18, Issue 2 , Pages 157-168 , April 2005