Abstract
Objective The aim of this study is to analyze various rehabilitation protocol and determine
which methods will yield a better outcome.
Methods The database reports were searched within 1990 until 2020, using PubMed, Cochrane
library database, Ovid, Medline, and the other several published trials. A statistical
analysis was made from Review Manager and Trial Sequential Analysis (TSA).
Result The mean of re-rupture rate is 3.3% (n = 8) in the combination protocol until 8% (n = 48) in CAM protocol. Meta-analyses found no significant difference between Kleinert
vs CAM in re-rupture rate. Also no significant difference in Duran vs CAM in rerupture
rate. In Trial Sequential Analysis (TSA), the z-curve does not cross both of the trial
sequential boundaries, a further trial with larger sample will be required. The TSA
of flexion contracture CAM vs Kleinert was indicated that CAM protocol may be superior
than Kleinert to reduce the incidence of flexion contracture. For the range of mean
flexion contracture 6.6% (n = 18) in CAM to 23.6% (n = 76) in Kleinert protocol.
Conclusion Current meta-analysis proposed that the combination technique will result less re-rupture
incidence and better functional outcome in flexor zone II injuries than other techniques.
The CAM method also results less flexion contracture than others. However, a further
meta-analyses with larger sample trials will be required to confirm this review's
conclusion.
Keywords tendon injuries - postoperative care - surgical procedures, operative
