This document discusses various protocols for rehabilitation after flexor tendon injuries, including passive motion protocols like the Kleinert technique and Duran protocol. The Kleinert technique uses a dorsal blocking splint with elastic bands to passively flex and extend the fingers, while the Duran protocol uses a splint and passive motion of individual finger joints within the splint. Early active motion protocols allow more force and excursion but require stronger surgical repairs. Immobilization protocols initially use casts or splints before beginning motion.

1. Kleinert and Duran Protocols

2. Tendon motion
rehabilitation
protocols
Passive motion
protocols (low force
and low excursion)
Kleinert technique
Duran protocol
Early active motion
protocols—Moderate
force and potentially
high excursion
Dorsal blocking splint
Synergistic motion
regimen—Low force
and high tendon
excursion
Immobilization
protocols
Cast or splints
Boyer MI. AAOS comprehensive orthopaedic review 2. Lippincott Williams & Wilkins; 2018 Aug 31.

3. Passive motion protocols (low force and low
excursion)
• Requires strict patient compliance
• Avoidance of active flexion for 6 weeks
• Newer advancements: Components of early active digital flexion added to reduce adhesion
formation and increase tendon excursion
• Require stronger repair methods (use of a minimum of four core sutures).
Miller MD, Thompson SR. Miller's Review of Orthopaedics E-Book. Elsevier Health Sciences; 2019 Oct 5.

4. Kleinert Protocol
• Uses a dorsal block splint with the wrist in 45° of
flexion and elastic bands secured to the patient’s
nailsand a more proximal attachment point
• After the interphalangeal joints are actively fully
extended, recoil of the elastic bands flexes them down
passively.
Boyer MI. AAOS comprehensive orthopaedic review 2. Lippincott Williams & Wilkins; 2018 Aug 31.
Lund AT. Flexor tendon rehabilitation: a basic guide. Operative Techniques in Plastic and Reconstructive Surgery. 2000 Feb 1;7(1):20-4.

5. Vucekovich K, Gallardo G, Fiala K. Rehabilitation after flexor tendon repair, reconstruction, and tenolysis. Hand Clinics. 2005 May 1;21(2):257-65.

6. Duran Protocol
• Uses a splint with the wrist in 20° of flexion
• Passive range-of-motion program of isolated IP and MCP joint passive motion
• Patient passively flex and extend the PIP joint of the affected finger while holding the DIP
and MCP joints flexed, and then passively move the DIP joint into extension and flexion
with the MCP and PIP joints flexed.
• All of the exercises are performed within the confines of the splint.
Wolfe SW, Pederson WC, Kozin SH, Cohen MS. Green's operative hand surgery. Elsevier Health Sciences; 2021 Dec 3.
Boyer MI. AAOS comprehensive orthopaedic review 2. Lippincott Williams & Wilkins; 2018 Aug 31.
Lund AT. Flexor tendon rehabilitation: a basic guide. Operative Techniques in Plastic and Reconstructive Surgery. 2000 Feb 1;7(1):20-4.

7. Wolfe SW, Pederson WC, Kozin SH, Cohen MS. Green's operative hand surgery. Elsevier Health Sciences; 2021 Dec 3..

8. Vucekovich K, Gallardo G, Fiala K. Rehabilitation after flexor tendon repair, reconstruction, and tenolysis. Hand Clinics. 2005 May 1;21(2):257-65.