Efficiency of the flexor tendon pulley system in human cadaver hands

Rispler, David; Greenwald, Daniel P.; Shumway, Scott; Allan, Christopher H.; Mass, Daniel P.

doi:10.1016/s0363-5023(96)80361-3

Cited by 47 publications

(16 citation statements)

References 15 publications

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“…Multiple studies have validated the significance of the A2 and A4 pulleys with respect to effective finger flexion, and more recent studies have appropriately focused on WOF as a relevant outcome measure2–5. Peterson et al concluded that A2 and A4 are the most and second most important pulleys, respectively, based on their findings that loss of the A4 pulley resulted in a 20% increased WOF.…”

Section: Discussionmentioning

confidence: 99%

“…This positioning of the tendons is critical for maintaining normal finger function1. The relative importance of each pulley (Palmar aponeurotic [PA], A1-5, and C1-3) has been extensively studied, and most studies support the concept that the A2 and A4 pulleys are the most crucial to maintain normal digital function by preventing bowstringing and loss of finger flexion2–5. Consequently, early recommendations advocated repair or reconstruction of the pulleys6.…”

Section: Introductionmentioning

confidence: 99%

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Quantification of Partial or Complete A4 Pulley Release With FDP Repair in Cadaveric Tendons

Franko

Lee

Finneran

et al. 2011

The Journal of Hand Surgery

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Purpose Repair of a lacerated flexor digitorum profundus (FDP) tendon underneath or just distal to the A4 pulley can be technically challenging, and success may be confounded by tendon triggering and scarring to the pulley. The purpose of this study was to quantify the effect of partial and complete A4 pulley release in the context of a lacerated and repaired FDP tendon just distal to the A4 pulley. Methods Tendon biomechanics were tested in six cadaveric hands secured to a rigid frame permitting measurement of tendon excursion, tendon force, and finger range of motion. After control testing, each finger underwent laceration and repair of the FDP tendon at the distal margin of the A4 pulley using a six-strand core suture technique and epitendinous repair. Testing was then repeated after the following interventions: 1) Intact A4 pulley 2) Release of the distal half of the A4 pulley, 3) Complete release of the A4 pulley, and 4) Continued proximal release of the sheath to the distal edge of A2 (release of C2, A3, and C1 pulleys). Release of the pulleys was performed by incision; no tissue was removed from the specimens. Results From full extension to full flexion, average profundus tendon excursion for all intact digits was 37.9 ± 1.5 mm, and tendon repair resulted in average tendon shortening of 1.6 ± 0.4 mm. Flexion lag increased from less than 1 mm to over 4 mm with venting of the A4 pulley, complete A4 release, and proximal sheath release, respectively. Compared to the intact state, repair of the tendon with an intact A4 pulley, release of half the A4 pulley, complete A4 release, and proximal sheath release resulted in percent increases in work of flexion (WOF) of 11.5 ± 3.1%, 0.83 ± 2.8%, 2.6 ± 2.4%, and 3.25 ± 2.2%, respectively (p<0.05). Conclusions After FDP laceration and repair in the region of the A4 pulley, WOF did not increase by more than 3% from control conditions after partial or complete A4 pulley release, and WOF was significantly less than performing a repair and leaving the A4 pulley intact.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantification of Partial or Complete A4 Pulley Release With FDP Repair in Cadaveric Tendons

Franko

Lee

Finneran

et al. 2011

The Journal of Hand Surgery

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“…Regarding the pulleys, some authors consider that the preservation of the A2 and A4 is essential [16,26], but some others [29,32,35] advocate that partial incision of A2 and complete excision of A4 do not affect the functional outcome. On the contrary, that allows tendon gliding while avoiding clinically significant bowstringing [32].…”

Section: Discussionmentioning

confidence: 99%

Modified Brunelli Pull-Out Technique in Flexor Tendon Repair for Zone II: A Study on 58 Cases

Georgescu

Matei

Capota

et al. 2011

Hand (New York, N,Y.)

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“…Loss of the integrity of these pulleys results in bowstringing. 17 In our study we reconstructed A 2 and A 4 pulleys using remnants of flexor digitorum superficialis tendon in first stage of tendon reconstruction.…”

Section: -11mentioning

confidence: 99%