EFFICACY COMPARISON OF VARIOUS REPAIR TECHNIQUES FOR FLEXOR TENDON INJURIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Flexor tendon injuries are potentially disabling, as flexor tendons are essential to hand function, playing a vital role in all types of grip, including power grip and fine pinch grip.  However, there has been no consensus regarding the most effective repair technique for this pathology.Methods: A systematic search was conducted based on PRISMA guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane. A total of 9 studies (266 tendons from 108 patients) were included.Results: In comparison between Modified Kessler and Four-stranded Cruciate technique, Four-stranded Cruciate Suture produces higher 2 mm gap strength (I2= 93%, P< 0.00001), higher ultimate strength (I2= 99%, P=0.02), and better Functional Outcome as measured by Strickland Criteria (I2=0%, P< 0.0001). In comparison between the 2-Stranded and the 4-Stranded Kessler technique. The 4-Stranded Kessler technique produces higher 2 mm gap strength (I2= 98%, P=0.02) and higher ultimate strength (I2= 60%, P<0.00001).Conclusion: Current systematic review and meta-analysis suggest that the 4-stranded cruciate repair technique has better strength and functional outcome than the modified Kessler, especially in zone II and III injuries. Four-stranded Kessler is also proven to have better strength compared to the two-stranded Kessler.