6. Postoperative rehabilitation following flexor tendon repair

An understanding of the postoperative rehabilitation regimen after flexor tendon repair is of equal importance to the repair itself. Noncompliance with rehabilitation may lead to poor outcomes including repair rupture, decreased range of motion and joint stiffness. Current postoperative protocols for patients with flexor tendon injuries are immobilisation, early passive mobilisation and early active mobilisation [73, 74].

### 6.1 Immobilisation

The benefits of early mobilisation on the repair strength, tenocyte healing and formation of adhesions are widely known [22, 75–79]. Immobilisation, however, has its role in certain situations, particularly in patients who are noncompliant with early mobilisation protocols, paediatric patients, patients with cognitive deficits and patients with concurrent injuries that may be worsened with early active mobilisation (fractures, nerves and vessels) [73, 74].

It is difficult to encourage early mobilisation in children under the age of 6 [80]. O'Connell et al. showed outcomes were equal among children who were immobilised and those who underwent early mobilisation for 4 weeks [81]. However, immobilisation for more than 4 weeks resulted in functional deterioration of the repaired tendon [81].

The protocol of Cifaldi, Collins and Schwarze may be used for the noncompliant adult [73, 82]. This protocol involves 3–4 weeks of immobilisation in a forearmbased dorsal splint or cast (20° wrist flexion, MP joints in 50° flexion and the IP joints in full extension) followed by a weaning programme (it may also be used in children) [74, 82]. "Weaning" refers to modifying the splint in such a way that the wrist is in neutral and then instructing the patient to remove the splint every hour to passively flex and extend the injured digit for 10 repetitions. Splint wear is then
