The accuracy of preoperative ultrasound use in primary flexor tendon repair: A systematic review.

Introduction: Flexor tendon injuries disrupt hand function and require precise surgical repair. Traditionally assessed through physical examination alone, ultrasound scanning (USS) is emerging as a valuable tool, offering real-time, non-invasive imaging to assess injury type and extent. This review evaluates the USS's accuracy in preoperative flexor tendon assessment. Methods: Following PRISMA guidelines, a systematic review was conducted using MEDLINE, EMBASE, and Web of Science. Studies on primary flexor tendon injuries assessed with preoperative USS were included, while non-clinical studies, animal models, and incomplete datasets were excluded. Two reviewers screened articles, with disagreements resolved by a third reviewer. Results: From 1354 initial studies, nine met inclusion criteria, comprising one RCT, four prospective, and four retrospective studies. In total, 450 patients (593 tendons) with diverse injuries were assessed. USS sensitivity and specificity were high for complete tears (88.78 % and 92.23 %) but lower for partial tears (0.67 % and 66 %). Discussion: USS provides an effective, non-invasive method for identifying complete flexor tendon injuries, reducing the need for exploratory surgery, facilitating targeted incisions, and potentially shortening operative times. By enabling accurate surgical planning, USS helps minimize dissection and trauma, aligning with sustainable healthcare practices. Its application in delayed presentations also guides repair strategies, enhancing outcomes through more precise tendon localization. Level of evidence: IIIA.