Reliability of Tendon Excursion Measurements in Patients Using a Color Doppler Imaging System Johannes N. M. Soeters, Marij E. Roebroeck, PhD, Wim P. J. Holland, MSc, Steven E. R. Hovius, MD, PhD, Hendrik J. Stam, MD, PhD, Rotterdam, The Netherlands Purpose: The purpose of this study was to assess the test-retest reliability of tendon excursion measurements with color Doppler imaging in patients with flexor tendon injuries following a modified Kleinert protocol. Methods: One observer performed repeated measurements at 3 different time periods in 13 patients with flexor tendon injuries, following a modified Kleinert protocol. The intraclass corre- lation coefficient (ICC), the standard error of measurement (SEM), and related indices of measure- ment error were calculated. Results: Measurements at 10 day after surgery had an ICC of .88 and an SEM of 1.1 mm. Measurements at 6 weeks after surgery had an ICC of .58 and an SEM of 2.0 mm. The measure- ments after 3 months had an ICC of .94 and an SEM of 1.2 mm. Conclusion: Measurements at 10 days and more than 3 months after surgery were reliable and were as reliable as the measurements performed on healthy subjects. At 6 weeks after surgery the measurements were less reliable. Color Doppler imaging is a reliable and noninvasive method to assess tendon excursion, even in patients with small tendon excursion movements. (J Hand Surg 2004;29A:581–586. Copyright © 2004 by the American Society for Surgery of the Hand.) Key words: Tendon excursion, test-retest reliability, color Doppler imaging, hand, patients. The aim of postoperative management of finger flexor tendon laceration is to minimize adhesions while protecting the suture tendon interface and the suture itself. In the commonly used Kleinert protocol active extension followed by passive flexion of the distal and the proximal interphalangeal joints induces tendon excursion. 1 From experimental and clinical observations Duran and Houser 2 in 1975 concluded that 3- to 5-mm motion of the repaired tendon was sufficient to prevent firm adherence of that repaired flexor tendon. Silfverskio ¨ld et al 3 in 1993 found a relation between tendon excursion and adhesion for- mation and clinical results. For the tendon to move it has to overcome the resistance between the sutured tendon and its sheath. This resistance depends in part on the used suture technique and almost equals the force that is induced by passive motion. 4 In this way From the Department of Rehabilitation Medicine, Experimental Medical Instrumentation, Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands. Received for publication July 21, 2003; accepted in revised form April 8, 2004. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Supported by a grant from the revolving fund from the University Medical Center Rotterdam. Reprint requests: Johannes N. M. Soeters, Department of Rehabilita- tion Medicine, Erasmus MC—University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Copyright © 2004 by the American Society for Surgery of the Hand 0363-5023/04/29A04-0005$30.00/0 doi:10.1016/j.jhsa.2004.04.021 Note: To access the video accompanying this article, visit the July 2004 online issue of Journal of Hand Surgery at www.jhandsurg.org. The Journal of Hand Surgery 581