Prospective cohort from Belfast evaluating early active finger mobilization — commenced within 48 hours — as routine postoperative therapy for zone 2 flexor tendon repairs. 98 of 114 patients (86%) with 117 injured digits were reviewed at minimum six months. The study reports functional outcomes by ASSH and Kleinert grading criteria and tracks dehiscence, extension deficit, and secondary procedure rates.
Zone 2 flexor tendon repair earned its reputation as "no man's land" because immobilization led to dense adhesions and the Kleinert elastic-band protocol, while effective in Louisville, was rarely reproduced elsewhere. This series showed that disciplined early active mobilization — twice-weekly supervised therapy, two-hourly home exercises, full passive range by week one. Could match or beat Kleinert outcomes in a general plastic surgery unit, not just a specialized hand center.
In the clinic, two decision rules follow directly from this data. First, when you repair a little finger in zone 2, counsel the patient explicitly about a 25% rupture risk and review them more frequently in those first two weeks. Second, when a patient reports sudden loss of active flexion after repair, treat it as a surgical emergency: re-explore, re-repair, and restart the mobilization protocol immediately. 64% will still achieve a good result if you act within 48 hours.
The 30-degree PIP extension lag threshold is worth memorizing: in this series, every digit with a lag exceeding 30° ended with a poor outcome, making it a reliable clinical red flag that warrants dynamic splinting rather than passive stretching alone.
Prospective cohort from Belfast evaluating early active finger mobilization — commenced within 48 hours — as routine postoperative therapy for zone 2 flexor tendon repairs. 98 of 114 patients (86%) with 117 injured digits were reviewed at minimum six months. The study reports functional outcomes by ASSH and Kleinert grading criteria and tracks dehiscence, extension deficit, and secondary procedure rates.
Zone 2 flexor tendon repair earned its reputation as "no man's land" because immobilization led to dense adhesions and the Kleinert elastic-band protocol, while effective in Louisville, was rarely reproduced elsewhere. This series showed that disciplined early active mobilization — twice-weekly supervised therapy, two-hourly home exercises, full passive range by week one. Could match or beat Kleinert outcomes in a general plastic surgery unit, not just a specialized hand center.
In the clinic, two decision rules follow directly from this data. First, when you repair a little finger in zone 2, counsel the patient explicitly about a 25% rupture risk and review them more frequently in those first two weeks. Second, when a patient reports sudden loss of active flexion after repair, treat it as a surgical emergency: re-explore, re-repair, and restart the mobilization protocol immediately. 64% will still achieve a good result if you act within 48 hours.
The 30-degree PIP extension lag threshold is worth memorizing: in this series, every digit with a lag exceeding 30° ended with a poor outcome, making it a reliable clinical red flag that warrants dynamic splinting rather than passive stretching alone.