Pulley Plasty Versus Resection of One Slip of the Flexor Digitorum Superficialis After Repair of Both Flexor Tendons in Zone Ii

Primary Tendon Sheath Enlargement and Reconstruction in Zone 2: An In Vitro Biomechanical Study on Tendon Gliding Resistance

“…13,18 Palliard et al reported improved gliding in cadaver fingers after a pulley plasty. 19 This study measures the effect of pulley enlargement by incision and grafting in a controlled experimental setting in human anatomic specimens, by measuring flexor tendon gliding resistance using the method of Uchiyama et al 20 at a fixed 50°angle at "time zero" under 3 conditions. Our hypothesis is that sheath enlargement with graft repair will reduce tendon gliding resistance and thereby improve tendon repair gliding through the proximal sheath, including the A2 pulley.…”

Effect of A2 Pulley Release on Repaired Tendon Gliding Resistance and Rupture in a Chicken Model

“…tude. 4,13,14 Here, we demonstrate another important benefit of this pulley-release procedure, which is pertinent to prevention of postsurgical tendon overload and repair ruptures. Pulley venting decreased rupture rates of the repaired tendons, the gliding force of the repaired tendons, the work required to move the repaired digits, and the number of motion cycles necessary to reach steady lower resistance to tendon motion during cyclic digital motion.…”

“…[1][2][3][4][5][6][7][8][17][18][19] Recently, surgeons have challenged the notion of strict preservation of major pulleys during primary tendon repairs. 1-5,9 -14,20 Investigations of pulley release have involved clinical studies, 1,5 biomechanical studies using cadaveric hands, 9,11,12 or biomechanical and morphological analysis in animal models after primary tendon repairs when tendon healing is accomplished.…”

Gliding Resistance and Triggering After Venting or A2 Pulley Enlargement: A Study of Intact and Repaired Flexor Tendons in a Cadaveric Model

“…Previously, proposed methods for promoting tendon gliding included pulley venting, 1-3 removing one slip of the flexor digitorum superficialis, 4 -6 pulley enlargement by local tissue advancement, 7 pulley-plasty, 4 complete pulley transection without repair, 2,8 and pulley enlargement with grafting. 9 -11 This wide array of techniques suggests both that the surgeon encounters a variety of circumstances and that there is uncertainty of the best way to manage sheath resistance, to avoid triggering of the repair, and to control bowstringing in order to improve clinical outcomes.…”

“…9 -11 This wide array of techniques suggests both that the surgeon encounters a variety of circumstances and that there is uncertainty of the best way to manage sheath resistance, to avoid triggering of the repair, and to control bowstringing in order to improve clinical outcomes. [2][3][4]6,8,[12][13][14][15][16] Currently, venting is a commonly used method to ease tendon gliding and avoid triggering, both of which have been related to rupture of the tendon repair. 1,2,4,6,8,12,13,[15][16][17] Clinical reports, however, suggest that venting might not be the answer to the concerns of sheath management.…”