الفهرس 
ANATOMY OF THE FLEXOR TENDONSOnly 14 pages are availabe for public view
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Abstract
Z
one II Flexor tendon injuries of the hand are a challenging problem for surgeons due to three main reasons. Firstly, such injuries cannot heal without surgical treatment. Secondly postoperative management needs to be carefully planned as mobilization has shown to be essential to prevent adhesions and improve gliding but this carries the risk of rupture. Lastly due to the unique anatomy in the region, in this zone, both the flexor digitorum profundus and flexor digitorum superficialis must glide within a synovial sheath through a series of fibro-osseous pulleys, surgeons have to avoid increasing the bulkiness of the tendon through its sheath, as this may affect the functional outcome of the tendon.
Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur. The most common complication is adhesion formation, which limits active range of motion; therefore, enhancing the quality of repaired tendon is mandatory, which may need biologic adjuvants for tendon healing.
PRP contains many of the growth factors thought to be important in tendon healing, including PDGF, IGF-1, TGF-β, VEGF, bFGF, and EGF, thus it has the ability to deliver a super-physiologic doses of these growth factors that are beneficial in tendon healing. Multiple in vitro studies have shown the effect of PRP on tendons. PRP has been reported to induce the proliferation of the two tendon cell types, tenocytes and tendon stem/progenitor cells (TSCs).
PRP can also influence the metabolism of tendon cells involved in the wound healing process. PRP was shown to increase total collagen synthesis in both tenocytes and TSCs and specifically enhance the gene expression of collagen types I and III.
We studied the effect of PRP on the outcome of zone II flexor tendon repair and the range of motion. Forty cases were included in our study which had zone II flexor tendon injury repaired using four strands cruciate repair technique and they were divided into 2 groups. group I was injected with PRP after 1 and 6 weeks post-operatively, group II without PRP injection and both groups had the same protocol of physiotherapy and were followed up for 3 months. Results were measured as regard the total range of motion according to Buck-Gramko criteria showing no significant change in the range of motion between the two groups.
CONCLUSION AND RECOMMENDATIONS
PRP application in zone II flexor tendon injury after repair did not show significant improvement of the gliding of the tendon and range of motion of PIP joint in the interventional group in comparison to the control group.
Further studies with different injection protocols or different adjuvant substances is mandatory to study the effect of PRP injection on the outcome of tendon repair specially zone II.