Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum Follow-Up of a Randomized Controlled Trial.

Purpose: There is no consensus on the optimal postoperative rehabilitation program following flexor tendon repair. Some studies suggest a faster recovery after active mobilization, whereas other studies have failed to find any differences between active and passive mobilization at 12 months. To our knowledge, no prior randomized controlled trial has compared the long-term effects of these two approaches. This randomized controlled trial compared the long-term outcomes of active mobilization with those of passive mobilization in combination with place-and-hold.

Methods: Sixty-four patients with a flexor tendon injury in zones I or II were included in the study. After surgery, patients were randomized to either active mobilization or passive mobilization with place-and-hold. Forty-seven patients were available for the 5-year minimum follow-up. Assessments included range of motion, grip strength, key pinch, as well as the Disabilities of the Arm, Shoulder, and Hand (DASH) and ABILHAND questionnaires.

Results: At the 5-year minimum follow-up, range of motion was significantly better in the group treated with passive mobilization with place-and-hold compared with the active mobilization group. Furthermore, there was a significant deterioration in the range of motion and an increased flexion contracture in the active mobilization group compared with 1 year after surgery. Grip strength deteriorated significantly in both groups from the 1-year to the 5-year minimum follow-up, but key pinch did not change. In both groups, DASH and ABILHAND scores improved from the 1-year to the 5-year minimum follow-up.

Conclusions: Passive mobilization with place-and-hold following flexor tendon repair results in superior long-term outcomes compared with active mobilization.

Type of study/level of evidence: Therapeutic I.