Comparison of Kleinert versus Saint John protocol in Zone I/II flexor tendon injuries: A retrospective study

Background: There is no concrete evidence to define the optimal mobilization strategy following zone I/II flexor tendon repair. The Saint John Protocol is an active motion regime which utilizes wrist movement to facilitate better clinical outcomes. Our objective was to compare the outcomes of patients who underwent the conventional Kleinert protocol versus the Saint John protocol. Methods: 20 fingers in the Kleinert group and 18 fingers in the Saint John group were included in this retrospective study. Pain score, range of movement, grip strength, and complications were studied at 6 and 12 weeks postoperatively. Results: The Saint John protocol showed significantly less pain at 6 week (0.167 vs 1.08, P = 0.032) and less flexion contracture at the PIPJ at 6 weeks (3.33 vs 12.25, P = 0.032). Both groups showed similar rerupture rates (5.5% vs 5%). Conclusions: Saint John protocol demonstrated better clinical outcomes while not sacrificing the integrity of repair.