Year: 2026 | Month: September | Volume: 13 | Issue: 9 | Pages: 13-18
DOI: https://doi.org/10.52403/ijrr.20260903
The Role of Active and Passive Mobilization Techniques in Early Recovery After Flexor Tendon Repair: A Systematic Review
Bambang Tutuko1, AA. Gde Yuda Asmara2
1Department of Orthopaedic and Traumatology, Prof Ngoerah Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia
Corresponding Author: Bambang Tutuko
ABSTRACT
Background: Flexor tendon injuries, particularly in Zone II, remain among the most complex challenges in hand surgery. Optimal postoperative rehabilitation is essential to balance tendon protection and early motion. Rehabilitation strategies vary from passive mobilization protocols such as the modified Kleinert and modified Duran, to hybrid techniques like Place-and-Active-Hold (PAH), and fully active regimens such as Controlled Active Motion (CAM). Each technique differs in timing, supervision, and degree of tendon loading, influencing functional recovery and complication rates. This systematic review compares these technique-specific rehabilitation protocols to evaluate their impact on early recovery, complications, and patient-centered outcomes following flexor tendon repair.
Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Embase, Scopus, and CINAHL was conducted. Included studies were RCTs or prospective cohort trials comparing at least two of the following techniques: passive mobilization (modified Kleinert or Duran), hybrid (PAH), or active (CAM) after zone II flexor tendon repair. Data were extracted for functional outcomes (Total Active Motion [TAM], PIP/DIP milestones, grip strength), complications (rupture, adhesions, flexion/extension lag), and patient-centered outcomes (pain, satisfaction, early return to ADLs). Rehabilitation details such as splint design, exercise frequency, and supervision level were analyzed.
Results: Four eligible studies encompassing 215 patients met inclusion criteria. Active (CAM) protocols yielded the fastest early functional recovery, followed by hybrid (PAH) programs, while passive (Kleinert/Duran) techniques demonstrated slower progress. Early TAM, PIP/DIP flexion, and grip strength were highest in CAM groups. Hybrid protocols (PAH) offered a safer middle ground with superior early motion compared to passive regimens and without increased rupture risk. Complications—including adhesions and flexion lag—were reduced in CAM and PAH groups, while rupture rates remained comparable across all methods. Patient satisfaction and early return to ADLs were significantly greater among those undergoing active or hybrid protocols. Long-term results converged across all groups after 12–16 weeks.
Conclusions: Rehabilitation after flexor tendon repair should be viewed as a continuum of motion—progressing from passive to hybrid to active techniques as healing allows. CAM and PAH programs promote earlier tendon glide, improved functional outcomes, and greater patient satisfaction without compromising safety. Passive regimens remain useful in high-risk repairs but should transition to controlled motion when feasible. These findings highlight the importance of technique-specific protocol selection and individualized rehabilitation planning to optimize early recovery.
Keywords: Flexor tendon repair, Rehabilitation protocols, Controlled Active Motion, Place-and-Active-Hold, Modified Kleinert, Modified Duran, Early functional recovery
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