A2-PULLEY RECONSTRUCTION: A COMPARISON OF THREE TECHNIQUES IN A CADAVERIC MODEL AND REVIEW OF THE LITERATURE

P. Gravina¹, F. De Francesco^2*, P.P. Pangrazi², A. Gigante¹ and M. Riccio²

¹Clinical Orthopaedics, Department of Clinical and Molecular Science, Polytechnic University of Marche, Ancona, Italy;
²Department of Plastic and Reconstructive Surgery-Hand Surgery Unit, Azienda ‘Ospedali Riuniti’ Ancona, Italy

*Correspondence to:
Francesco De Francesco, MD
Department of Plastic and Reconstructive Surgery-Hand Surgery Unit,
Azienda ‘Ospedali Riuniti’,
Ancona, Italy
e-mail: francesco.defrancesco@ospedaliriuniti.marche.it

Received: 04 January 2023 Accepted: 10 February  2023

ISSN: 1973-6401 Copyright © by BIOLIFE (2023) This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

Reconstruction of flexor tendon pulleys presents serious problems for the hand surgeon. The clinical result after reconstruction efforts in a flexor tendon-pulley unit depends on restoration of grip strength and active range of motion of the finger. Eight forearms were used to evaluate excursion resistance by range of motion and strength resistance of three different A2 pulley reconstruction (Bunnell’s, modified Odobescu technique, pulley venting). The results of the in vitro study of excursion resistance and strength resistance of pulley reconstruction demonstrated that the three techniques have similar results, Bunnel’s one just brought a better flexion for PIP joint flexion but pulley venting can be considered a second choice for that patients who has the anatomical absence of palmaris lounges (15% of people). The triple loop can be considered as the best choicefor A2 pulley reconstruction, in terms of strength and articular range of motion, in that cases where the techniques in not affordable, pulley venting can be considered a solid second choice for its results similar to the triple loop techniques, for the absence of tendon sacrifice and for the fast execution time.

KEYWORDS: pulley, pulley venting, free tendon loop, tendon gliding, cadaveric model