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Is releasing pulleys during flexor tendon repair “part and parcel”? Narrative review of the current evidence

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The complex hand flexors pulleys system is essential in achieving efficient flexor tendons’ function. Previous cadaveric studies demonstrated that A2 and A4 are the crucial pulleys in maintaining normal digits biomechanics. Realistically, the preservation of A2 and A4 pulleys during repairing flexor tendon laceration in zones one and two can be extremely challenging. We review the current published evidence in this article to answer the question of whether releasing the pulleys cause bowstringing or affects clinical outcomes.

Methods

Literature search of the available databases.

Results

There was no published comparative evidence. Retrospective case series have reported that no clinical bowstringing was noted after releasing flexor pulleys during flexor tendon repairs. Outcomes have been reported according to Tang and or Strickland criteria to assess range of motion (ROM). No functional hand scores or patients’ satisfactions scores have been reported.

Conclusion

Releasing flexor pulleys during tendon repair to allow access or prevent impingement of the repaired tendon does not seem to cause bowstringing or affect outcome based on the limited available evidence. Future research is needed.

Level of evidence

Level 4.

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Authors and Affiliations

  1. Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK

    Amir Abdelmalek & John McFarlane

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  1. Amir Abdelmalek
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  2. John McFarlane
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Contributions

AA: conceptualisation, literature search and writing- original draft preparation. JM: supervision and writing- reviewing and editing.

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Correspondence to Amir Abdelmalek.

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Abdelmalek, A., McFarlane, J. Is releasing pulleys during flexor tendon repair “part and parcel”? Narrative review of the current evidence. Eur J Orthop Surg Traumatol 32, 1451–1457 (2022). https://doi.org/10.1007/s00590-021-03128-4

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