OBJECTIVE: To investigate the value of shear wave elastography (SWE) and blood flow parameters based on conventional ultrasound in evaluating healing status and functional recovery after surgical repair of hand flexor tendon lacerations.
METHODS: A prospective analysis was conducted on 58 patients (78 tendons) who underwent surgical repair of hand flexor tendon rupture from September 2024 to September 2025. Conventional ultrasound and SWE examinations were performed at 1, 2, 3, and 4 weeks after surgery to measure tendon thickness, blood flow grading, and shear wave velocity (SWVmean) at the suture site and adjacent tendons. The ratio was defined as (SWVmeanROI-1 + SWVmeanROI-3)/SWVmeanROI-2. Total active motion was assessed at 12 weeks after surgery. Pearson correlation and linear mixed-effects models were used to analyze temporal trends and prognostic associations.
RESULTS: The interobserver reliability for SWV was high (intraclass correlation coefficient > 0.80). Morphologically, tendon thickness peaked at week 2, while hypervascularity (grade 3) resolved from 41.0% at week 1 to 0% by week 4. Biomechanically, the suture zone progressively stiffened, whereas the adjacent stumps softened. Consequently, the elasticity ratio demonstrated a consistent monotonic decline (quadratic decay, P < .001). Importantly, the week 2 ratio was a significant independent predictor of 12-week functional outcomes, with lower ratios correlating with better total active motion (r = -0.68, P < .001).
CONCLUSION: Early postoperative SWE monitoring effectively captures the intrinsic stiffening process of the flexor tendon repair site. The elasticity ratio serves as a quantitative imaging biomarker that correlates significantly with long-term functional recovery. These findings provide in vivo biomechanical evidence that could facilitate the development of personalized, biology-guided rehabilitation protocols.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
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