Early Active Mobilisation Protocol following Six-strand Core Repair for Flexor Tendon Injury: A Prospective Observational Study

Introduction: Flexor Tendon Injuries (FTIs) in Zones II-V pose significant functional challenges due to adhesion formation and loss of tendon gliding. Early Active Mobilisation (EAM) following six-strand core repair improves outcomes by enhancing tendon healing while minimising complications. Aim: To evaluate the efficacy of EAM after six-strand flexor tendon repair by assessing functional recovery, grip strength and complications. Materials and Methods: A prospective observational study was conducted over 18 months at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India involving 38 patients (aged 18-60 years) with complete flexor tendon lacerations in Zones II-V. All patients underwent a sixstrand modified Kessler repair and received postoperative immobilisation in a dorsal splint. EAM was initiated on postoperative day 2, following the Belfast and Sheffield Mobilisation Protocol. Functional outcomes were assessed at 6, 8 and 12 weeks using the Buck-Gramcko II criteria, grip strength was measured using a Jamar dynamometer and pain was evaluated using a Numeric Pain Rating Scale (NPRS). Descriptive statistics were presented as means/standard deviations and medians/interquartile ranges (IQRs) for continuous variables, as well as frequencies and percentages for categorical variables. Group comparisons for categorical variables were conducted using the Chi-square test. Results: The mean age of patients was 26±5.5 years for females and 32±9.9 years for males. The study population comprised 30 males (78.95%) and 8 females (21.05%), with an age range of 18-60 years. The majority of injuries occurred in Zone V, involving 22 patients (57.89%). At 12 weeks, 20 patients (52.63%) achieved excellent outcomes, 13 patients (34.21%) had good outcomes, 3 patients (7.90%) had fair outcomes and 2 patients (5.26%) had poor outcomes. Most patients, i.e., 32 (84.21%), resumed work at six weeks. Grip strength improved to over 56 kg in 84.21% of cases and pain scores progressively decreased. Complications were minimal, with 1 patient (2.63%) experiencing a wound infection and 1 patient (2.63%) with skin necrosis; there were no tendon ruptures. Conclusion: EAM following six-strand flexor tendon repair is a safe and effective approach that promotes optimal functional recovery, reduces adhesions and facilitates an early return to work.