Comparative Study of Four- and Six-Strand Flexor Tendon Repair in Zone II

Flexor tendon injuries of Zone 2 are among the most difficult hand injuries to manage because of the complex anatomy and the tendency for adhesion formation and tendon rupture. Advances in tendon repair techniques have focused on increasing repair strength to permit early active mobilization while maintaining tendon gliding.

Four-strand repair techniques have been widely used and provide acceptable tensile strength and clinical outcomes. However, six-strand repair techniques may provide greater biomechanical stability and potentially allow safer early mobilization with lower rupture rates. Despite these theoretical advantages, there remains ongoing debate regarding the superiority of one technique over the other in terms of functional recovery and complication profile.

This prospective comparative study will be conducted in patients presenting with acute Zone 2 flexor tendon injuries of the hand. Eligible patients will undergo tendon repair using either four-strand or six-strand core suture techniques according to study allocation. All patients will follow a standardized postoperative rehabilitation protocol.

Primary outcomes will include functional assessment using total active motion and tendon rupture rates.

The findings of this study may help determine the optimal repair technique for improving functional outcomes in Zone 2 flexor tendon injuries while minimizing complications.

Inclusion criteria

• Male or female participants.
• Age 18 to 50 years.
• Zone II flexor tendon injury of the hand.
• Presentation within one week of injury.
• Willingness to participate and provide informed consent.
• Ability to comply with the postoperative rehabilitation protocol.

Exclusion criteria

• Injuries that interfere with postoperative rehabilitation.
• Extensive soft tissue damage associated with the tendon injury.
• Previous tendon injury in the same digit or hand region.
• Previous surgery in the same affected area.
• Non-compliance or anticipated inability to comply with the postoperative rehabilitation protocol.
• Evidence of a psychological or personality disorder that may affect participation or outcome assessment.
• Systemic illness that may compromise wound or tendon healing (e.g., uncontrolled diabetes mellitus, connective tissue disorders, severe vascular disease).