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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

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HAND

Abstract

Purpose

The purpose of this experiment was to determine the effect of A2 pulley reconstruction on gliding coefficient (GC), bowstringing, and proximal interphalangeal (PIP) joint maximum flexion angle after zone II repair of flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) lacerations.

Methods

Fresh frozen cadaver forearms were mounted, and the wrist and MCP joints fixed. FDS and FDP tendons were dissected free, and sequential loads were applied while digital images were captured. The dissected digit with intact native A2 pulley, FDS, and FDP tendons was used as the control (group 1). Zone II lacerations followed by four-stranded repair of FDP plus epitendinous suture and repair of FDS were then performed, and the data recorded (group 2). A2 pulley excision and reconstruction with a loop of palmaris longus autograft was then completed and the specimens sequentially loaded and photographed (group 3). Using the digital images, GC, bowstringing, and maximum flexion angle were calculated.

Results

No difference in maximum flexion angle was observed across the three testing conditions. Zone II laceration and subsequent FDS and FDP tendon repair significantly increased the GC for group 2 specimens; however, pulley reconstruction alleviated some of this increase for group 3. Bowstringing was significantly greater after pulley reconstruction, with a mean increase of 1.9 mm at maximum flexion for group 3 specimens relative to group 1 controls.

Discussion

Strong flexor tendon repairs are needed to prevent gap formation and subsequent triggering; however, the increased bulk from these large repairs can itself produce deleterious triggering, as well as tendon abrasion. Pulley reconstruction, in the setting FDP and FDS repair (group 3), significantly reduced the GC relative to tendon repair alone (group 2). While bowstringing was significantly greater after pulley reconstruction (group 3), it averaged only 1.9 mm over group 1 specimens and did not compromise maximum flexion angle compared to the uninjured controls (group 1) or the isolated tendon repair digits (group 2).

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Acknowledgments

This research was supported by NIH grant funding (1 K08 AR060164-01A) to support the involvement of the senior author.

Statement of Human and Animal Rights

This article does not contain any studies with human or animal subjects. For the purposes of this study, cadaveric specimens were obtained with consent from the Center for Anatomical Gifts at the University of Rochester Medical Center.

Conflict of Interest

SS, CE, ZY, JR, HA, and JE declare that they have no conflicts of interest.

Statement of Informed Consent

Individual consent for use of the cadaveric tissue is kept on file at the Center for Anatomical Gifts. All specimens were returned to the center at the conclusion of the study in accordance with the charter of the program for appropriate disposition as per the wishes of the donor.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA

    Spencer J. Stanbury, Christopher English, Zaneb Yaseen, Jeffrey D. Reed, Tony Chen, Hani Awad & John C. Elfar

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  1. Spencer J. Stanbury
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  2. Christopher English
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  3. Zaneb Yaseen
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  7. John C. Elfar
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Correspondence to John C. Elfar.

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Stanbury, S.J., English, C., Yaseen, Z. 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 9, 99–104 (2014). https://doi.org/10.1007/s11552-013-9560-3

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  • DOI: https://doi.org/10.1007/s11552-013-9560-3

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