Early mobilization versus immobilization after flexor tendon repair of the hand: A systematic review

Abstract

Introduction: Flexor tendon injuries of the hand, particularly those involving Zone II, remain a major clinical challenge because of their anatomical and biomechanical complexity. Despite advances in surgical repair techniques, postoperative recovery is often compromised by adhesion formation, joint stiffness, and the need to maintain adequate tendon gliding. Early mobilization protocols have been proposed as an alternative to conventional immobilization to improve functional outcomes after tendon repair. Objective: To compare the outcomes of early mobilization and conventional immobilization following flexor tendon repair of the hand and to provide evidence supporting the selection of safe and effective rehabilitation strategies. Methods: A systematic database search was conducted. Of the 188 studies selected from 2020 to 2026, 62 duplicates and 123 studies were excluded after the review of titles and abstracts. Three studies were included, totaling 184 participants. Results: Two randomized controlled trials were included in the analysis. In the first study (n = 64), early mobilization resulted in statistically significant and functionally superior outcomes compared with delayed mobilization. In the second study (n = 80), active and passive mobilization protocols showed comparable tendon rupture rates, with no statistically significant differences. A third eligible clinical study (n = 40) is ongoing, and its results have not yet been published. Conclusion: Early mobilization appears to provide superior functional recovery compared with conventional immobilization following flexor tendon repair of the hand. However, the limited number of available studies and their relatively small sample sizes highlight the need for further high-quality research to strengthen the current evidence base.