Shear wave elastography-based predictive model for early functional recovery following extensor tendon repair of the hand

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To investigate whether early postoperative shear wave elastography (SWE) parameters—specifically absolute stiffness and novel elasticity ratios reflecting regional stiffness gradients—can serve as early biomechanical proxies to predict 12-week functional outcomes. This prospective study included 65 patients (81 tendons) who underwent extensor tendon surgical repair. Conventional ultrasound and SWE were performed one week postoperatively. Absolute shear wave velocities (SWV) were measured at the distal tendon (ROI-1), suture site (ROI-2), and proximal tendon (ROI-3). Elasticity ratios (e.g., Ratio-3) were calculated to quantify the structural heterogeneity between the repair site and adjacent tissues. Functional recovery was evaluated using the Total Active Motion (TAM) score at 12 weeks. Linear mixed-effects and multivariable logistic regression models were utilized. Early SWE metrics demonstrated strong predictive value for 12-week TAM. Absolute stiffness at the suture site (SWVmean ROI−2 ) was positively associated with better functional recovery. Conversely, elasticity gradients (notably Ratio-3) exhibited a strong negative correlation with TAM ( r = -0.685, P < 0.001), indicating that an abrupt transition in tissue stiffness—which may predispose the tendon to localized stress concentration—predicts poorer outcomes. A comprehensive predictive model incorporating tendon thickness, Ratio-3, and SWVmean ROI−2 achieved an area under the curve (AUC) of 0.845 at the median TAM cutoff, improving to 0.911 for P75 outcomes, significantly outperforming single conventional parameters. Early postoperative SWE parameters, particularly suture site stiffness and derived elasticity ratios, are robust predictors of functional recovery following extensor tendon repair. The integrated predictive model shows promise for early, objective risk stratification, facilitating safe and individualized rehabilitation strategies. For patients with hand extensor tendon repairs, a predictive model incorporating shear wave elastography parameters and tendon thickness can accurately forecast functional recovery outcomes. This quantitative approach enables personalized rehabilitation protocols, optimizes timing of intervention, and significantly improves hand function restoration, providing surgeons with objective metrics for clinical decision-making.

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