Rerupture after flexor tendon repair of the hand and wrist: a retrospective risk factor analysis.

INTRODUCTION

Rerupture after primary flexor tendon repair of the hand and wrist is a serious complication that can substantially impair hand function and restrict activities of daily living, occupational performance, and recreation. Identifying factors associated with rerupture is essential to optimize surgical techniques and postoperative rehabilitation strategies and to improve patient outcomes.

METHODS

A retrospective observational cohort study was conducted including patients who underwent surgical repair of flexor tendon injuries of the hand and wrist at a single institution between 2010 and 2022. The study included 292 patients with 429 complete tendon injuries. Collected data comprised demographic characteristics, injury mechanism and type, anatomical location, surgical timing and technique, and postoperative immobilization and rehabilitation protocols. Associations between potential risk factors and rerupture were explored using univariable analyses, followed by a multivariable logistic regression model to identify independent predictors.

RESULTS

The overall rerupture rate was low but clinically relevant, occurring in a small proportion of patients and tendon lesions. Rerupture was more frequently observed in male patients, older individuals, and those with specific injury mechanisms. Surgical factors, particularly the need for pulley reconstruction, were associated with a higher risk of rerupture. All reruptures occurred in patients who underwent prolonged immobilization. In the multivariable analysis, male sex and pulley reconstruction remained independent predictors of rerupture, whereas rehabilitation-related variables did not independently influence risk.

CONCLUSION

This large single-center cohort study identifies male sex and pulley reconstruction as independent risk factors for rerupture following primary flexor tendon repair. Awareness of these factors may assist surgeons and therapists in patient counseling, risk stratification, and the development of tailored postoperative strategies. Prospective multicenter studies are warranted to confirm these findings and further refine preventive approaches. LEVEL OF EVIDENCE: Level III.