Background: After tendon repair, it is critical for the repair site to pass smoothly under the pulley edge to promote gliding and reduce the risk of adhesion or rupture. In this study, the authors assessed the effect of partial excision by "squaring off" the distal edge of the oblique pulley on the gliding resistance of the flexor pollicis longus tendon after repair in vitro.
Methods: Gliding resistance of 10 human thumbs was measured directly with three different sequential conditions: intact flexor pollicis longus tendon with intact A1 and oblique pulleys (group A), intact pulleys after repair of the tendon (group B), and after repair and excision of the distal triangular part (squaring off) of the oblique pulley (group C).
Results: Gliding resistance increased significantly after repair and squaring off the oblique pulley (group A, 0.22 +/- 0.08 N; group B, 1.29 +/- 0.68 N; and group C, 2.01 +/- 0.84 N).
Conclusions: Previous studies suggest that the trimming of an annular pulley in the finger would not result in any significant mechanical disadvantage if other parts of the pulley system were intact. However, the authors' results suggest that in the case of the thumb oblique pulley, gliding resistance is increased after trimming and tendon repair, and thus the oblique pulley should be left intact if possible.
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