Strickland's 1995 landmark review synthesizes 20 years of laboratory and clinical research on flexor tendon repair. It asks: what does the science actually say about tendon biology, repair mechanics, and rehabilitation — and how should it drive clinical decision-making? The review provides the evidence base for primary zone II repair with early controlled motion.
Zone II was once called surgical 'no-man's-land' — primary repair was abandoned in favor of delayed grafting because results were so poor. This review provided the scientific rationale that ended that era: early controlled motion accelerates healing and reduces adhesions, but only if the repair is strong enough to tolerate the load.
The practical rule this paper establishes: use a four-strand core repair combined with a running-lock or horizontal-mattress epitendinous suture. That construct survives passive motion (~500 g) and light grip (~1,500 g) with a safety margin throughout the healing period. When you see a zone II laceration, the decision tree is repair both FDP and FDS, build a strong multi-strand construct, and start early protected motion. Not immobilization.
For partial lacerations, the 60% threshold is the testable number: trim and smooth lacerations at or below 60%, repair those above it to prevent triggering and entrapment.
Strickland's 1995 landmark review synthesizes 20 years of laboratory and clinical research on flexor tendon repair. It asks: what does the science actually say about tendon biology, repair mechanics, and rehabilitation — and how should it drive clinical decision-making? The review provides the evidence base for primary zone II repair with early controlled motion.
Zone II was once called surgical 'no-man's-land' — primary repair was abandoned in favor of delayed grafting because results were so poor. This review provided the scientific rationale that ended that era: early controlled motion accelerates healing and reduces adhesions, but only if the repair is strong enough to tolerate the load.
The practical rule this paper establishes: use a four-strand core repair combined with a running-lock or horizontal-mattress epitendinous suture. That construct survives passive motion (~500 g) and light grip (~1,500 g) with a safety margin throughout the healing period. When you see a zone II laceration, the decision tree is repair both FDP and FDS, build a strong multi-strand construct, and start early protected motion. Not immobilization.
For partial lacerations, the 60% threshold is the testable number: trim and smooth lacerations at or below 60%, repair those above it to prevent triggering and entrapment.