Comparison of pulley plasty, pulley venting and resection of flexor digitorum superficialis slip after zone II flexor tendon repair: a cadaver study

Abstract

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. Level of evidence V