CME expires March 31, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

Flexor tendon injuries are associated with unique surgical and rehabilitation challenges, requiring a delicate balance between optimizing strength; preserving tendon gliding; and preventing complications, such as adhesions and rupture. This Instructional Course Lecture explores modern flexor tendon repair techniques, intraoperative assessment via WALANT (wide-awake local anesthesia no tourniquet), rehabilitation strategies, and treatment options for chronic tendon injuries necessitating reconstruction.

Editors
David J. Bozentka, MD, FAAOS
Chia Heng Wu, MD, FAAOS 

Learning Objectives

• Apply biomechanical principles of flexor tendon repair, including optimal suture techniques and tensioning strategies, and explore the role of core and epitendinous sutures in optimizing repair strength.
• Evaluate the indications for and advantages of WALANT (wide-awake local anesthesia no tourniquet) in patents undergoing flexor tendon repair, including its role in intraoperative functional assessment and intraoperative decision making.
• Recognize the role of early motion protocols in reducing adhesion formation while minimizing the risk of tendon rupture, and implement evidence-based rehabilitation strategies to maximize tendon gliding and function.
• Assess surgical considerations for complex flexor tendon injuries, including zone 1 flexor digitorum profundus avulsions, multi-zone lacerations, and combined tendon and pulley injuries, to select the most appropriate treatment option.
• Compare treatment options for chronic flexor tendon injuries, including delayed primary repair, tendon grafting, and two-stage reconstruction with the use of a Hunter rod.
• Identify and manage complications of flexor tendon repair, including rupture, adhesion formation, pulley dysfunction, and work of flexion resistance, via surgical refinement and rehabilitation adjustments.
• Optimize pulley treatment strategies to maintain tendon biomechanics, including selective venting of the A2 pulley during primary repair and staged reconstruction.
• Understand the effect of return-to-function principles in different patient populations, including high-demand athletes, manual laborers, and older adults, to tailor treatment and rehabilitation for long-term success.

Earn up to 5 AMA PRA Category 1 CME credits™.