A2 PULLEY INTEGRITY AND THE STRENGTH OF FLEXOR TENDON REPAIR: A BIOMECHANICAL STUDY IN A CHICKEN MODEL

Abstract

Purpose: This study assesses the influence of A2 pulley integrity on the strength of the repair. Method: Part 1- The flexor digitorum profundus (FDP) tendons of 72 Cobb chicken feet were severed and repaired in the region of the A2 pulley using a modified Kessler core suture and an epitendinous suture. The A2 pulley was either left intact, divided for 50% of its length, or divided in its entirety. The distal interphalangeal joint was fixed at a position of 20°, 40° or 60° of joint flexion. The load to failure, integrity of the A2 pulley and the site of tendon failure were analysed. Part 2- A further 32 chicken feet were used to exclude the effects of freezing and thawing on results and to analyse differences when using a core suture only. Results: No difference in failure load between any of the test groups or subgroups was identified. The integrity of the A2 pulley was preserved in all specimens. The most common cause of failure was distal suture pull-out. Discussion: This study does not demonstrate that release of the A2 pulley provides an advantage in increasing tendon repair strength. Division of 50% of the A2 pulley does not predispose to pulley rupture. Flexor tendon repair strength did not alter with distal interphalangeal joint flexion between 20° and 60°. Clinical Relevance: The findings of this study do not support division of the A2 pulley to prevent flexor tendon repair failure if repair methods of appropriate strength are utilised.