Four-Strand Modified Kessler versus Cruciate Technique for Repair of Zone Two Flexor Tendon Injuries: A Randomized Controlled Trial

Background. This is the first double-blinded randomized study in which the four-strand modified Kessler and the four-strand cruciate technique were compared in a series of zone II flexor tendon injuries in patients of working age (19–60 years old).Objective. To compare the functional outcomes of zone II flexor tendon repair with the four-core modified Kessler versus the four-core cruciate technique done at our institution's Hand Clinic.Methodology. This double-blinded randomized controlled trial was conducted from September 2022 to August 2023. The sample population consisted of eight fingers of eight patients who sustained traumatic zone II flexor tendon lacerations. Statistical analysis was made between the functional outcomes using the Strickland formula at the fourth, sixth, and eighth weeks, and the FIL-DASH (Disabilities of the Arm, Shoulder, and Hand - Filipino translation) score at the third, and sixth months postoperatively.Result. At weeks four, six and eight post-operatively, Strickland scores in the four-strand cruciate group were significantly higher than those in the four-strand modified Kessler group (p <0.02, p <0.03 and p <0.02). FIL-DASHscores at three and six months did not differ significantly between the groups.Conclusion. The four-core cruciate technique resulted in significantly better short-term functional outcomes than the four-core modified Kessler technique. More studies are needed to improve on these findings.