Three-loop technique for A2 pulley reconstruction

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A three-loop technique of secondary A2 pulley reconstruction has been developed by the authors. This method was applied to six fingers of six patients. The average follow-up period was 21 months and ranged from a minimum of 9 months to a maximum of 3 years. Total active motion of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints improved by 30° on the average from the preoperative 175° to the postoperative 205°. Similarly, tip palm distance showed an improvement of 10 mm on the average from the preoperative 32 mm to the postoperative 22 mm. Satisfactory grip functions were restored for all patients after the secondary pulley reconstruction.

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    Citation Excerpt :

    Several methods of pulley reconstruction have been described: the Kleinert and Bennett’s50 ever-present rim technique, in which a thin tendon graft is weaved back and forth through the rim of the pulley system; the Doyle and Blythe54 technique, in which drill holes are made in the phalanx through which a graft is passed and sutured back to itself; the Lister technique,55 in which a portion of the dorsal wrist extensor retinaculum is passed around the phalanx; the Karev technique,56 in which the volar plate is slit and used for pulley reconstruction. The authors prefer to use a palmaris autograft in a looped encircling reconstructive manner (Okutsu technique).57 In an in vitro study comparing 6 different reconstruction techniques, encircling looped techniques showed superior strength to failure compared with rim reconstruction techniques.58

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