Various techniques have been developed to optimize the repair of zone II flexor tendon injuries. The aim of the present study was to compare the biomechanical outcomes of four different methods: resection of the single flexor digitorum superficialis (FDS) slip; A2 pulley venting; and two different A2 pulley plasty methods. In total, 36 cadaveric fingers were dissected to determine the gliding coefficients (GC), maximum flexion angles (MFA) and bowstring measurements through digital imaging before and after surgical procedures. The GC increased significantly (p < 0.05) and MFA decreased significantly (p < 0.001) in all groups after the surgical interventions. There were no statistically significant differences between the surgical techniques regarding GC (p = 0.756) and MFA (p = 0.089). Bowstring distance significantly increased in the pulley venting group (p < 0.001). The pulley plasty results were comparable to the other techniques. The single FDS slip resection technique should be considered as the method of choice for reducing the GC following flexor tendon repair as it preserves the anatomical structure of the A2 pulley.
BrennerE.Human body preservation - old and new techniques. J Anat. 2014,
224: 316–44.
2.
BunataRESimmonsSRosoMKosmopoulosV.Gliding resistance and triggering after venting or A2 pulley enlargement: a study of intact and repaired flexor tendons in a cadaveric model. J Hand Surg Am. 2011,
36: 1316–22.
3.
DonaEWalshWR.Flexor tendon pulley V-Y plasty: an alternative to pulley venting or resection. J Hand Surg Br. 2006,
31: 133–7.
4.
DyCJHernandez-SoriaAMaYRobertsTRDaluiskiA.Complications after flexor tendon repair: a systematic review and meta-analysis. J Hand Surg Am. 2012,
37: 543–51.e1.
5.
GablMRanggerCLutzMFinkCRudischAPechlanerS.Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med. 1998,
26: 651–5.
6.
GearyMBEnglishCYaseenZStanburySAwadHElfarJC.Flexor digitorum superficialis repair outside the A2 pulley after zone II laceration: gliding and bowstringing. J Hand Surg Am. 2015,
40: 653–9.
7.
HasslundSJacobsonJADadaliT, et al.
Adhesions in a murine flexor tendon graft model: autograft versus allograft reconstruction. J Orthop Res. 2008,
26: 824–33.
8.
KapandjiIA.Reconstructive augmentation of the metacarpal tendons. Ann Chir Main. 1983a, 2: 281–2.
9.
KapandjiIA.Reconstructive augmentation of the metacarpal tendons. Ann Chir Main. 1983b, 2: 281–2.
10.
KlauserABodnerGFrauscherFGablMZur NeddenD.Finger injuries in extreme rock climbers. Assessment of high-resolution ultrasonography. Am J Sports Med. 1999,
27: 733–7.
11.
Kwai BenIElliotD.“Venting” or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries. J Hand Surg Br. 1998,
23: 649–54.
12.
KwonK-AShipleyRJEdirisingheM, et al.
Microstructure and mechanical properties of synthetic brow-suspension materials. Mater Sci Eng C Mater Biol Appl. 2014,
35: 220–30.
13.
LillySIMesserTM.Complications after treatment of flexor tendon injuries. J Am Acad Orthop Surg. 2006,
14: 387–96.
14.
McLarneyEHoffmanHWolfeSW.Biomechanical analysis of the cruciate four-strand flexor tendon repair. J Hand Surg Am. 1999,
24: 295–301.
15.
MoriyaKYoshizuTTsubokawaNNarisawaHMatsuzawaSMakiY.Outcomes of flexor tendon repairs in zone 2 subzones with early active mobilization. J Hand Surg Eur. 2017,
42: 896–902.
16.
MunzGPoggettiACenciLRizzoARBiondiMPfannerS.Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications. J Hand Surg Eur. 2021,
46: 818–24.
17.
NewmeyerWL3rdManskePR.No man’s land revisited: the primary flexor tendon repair controversy. J Hand Surg Am. 2004,
29: 1–5.
18.
NiumsawattVMaoDSalernoSRozenWM.Trigger finger release with stepwise preservation of the A1 pulley: a functional pulley-preserving technique. Int Surg. 2013,
98: 437–44.
19.
PaillardPJAmadioPCZhaoCZobitzMEAnKN.Pulley plasty versus resection of one slip of the flexor digitorum superficialis after repair of both flexor tendons in zone II: a biomechanical study. J Bone Joint Surg Am. 2002,
84: 2039–45.
20.
PetersonWWManskePRBollingerBALeskerPAMcCarthyJA.Effect of pulley excision on flexor tendon biomechanics. J Orthop Res. 1986,
4: 96–101.
21.
SchöfflVRSchöfflI.Injuries to the finger flexor pulley system in rock climbers: current concepts. J Hand Surg Am. 2006,
31: 647–54.
22.
StanburySJEnglishCYaseenZ, et al.
The effect of pulley reconstruction on maximum flexion, bowstringing, and gliding coefficient in the setting of Zone II repair of FDS and FDP: a cadaveric investigation. Hand (N Y). 2014,
9: 99–104.
23.
StirlingPHCMcEachanJE.In vitro testing of flexor tendon repair models: variability in the current literature. J Hand Surg Eur. 2023,
48: 162–8.
StricklandJW.Flexor tendon injuries: II. Operative technique. J Am Acad Orthop Surg. 1995,
3: 55–62.
26.
StricklandJW.Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg Am. 2000,
25: 214–35.
27.
TangJB.Flexor tendon repair in zone 2C. J Hand Surg Br. 1994,
19: 72–5.
28.
TangJBShiD.Subdivision of flexor tendon “no man’s land” and different treatment methods in each sub-zone. A preliminary report. Chin Med J (Engl). 1992,
105: 60–8.
29.
TangJBXieRG.Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing. J Hand Surg Am. 2001,
26: 855–61.
30.
TangJBXieRGCaoYKeZSXuY.A2 pulley incision or one slip of the superficialis improves flexor tendon repairs. Clin Orthop Relat Res. 2007,
456: 121–7.
31.
ZhaoCAmadioPCZobitzMEAnK-N.Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro. J Hand Surg Am. 2002,
27: 316–21.
