Biomechanical analysis of finger flexor pulley reconstruction

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Abstract
Fifty cadaver digits were used to study the mechanical properties of five different methods of pulley reconstruction and the effectiveness of three different pulley reconstructive arrangements in restoring a normal relationship between tendon excursion and joint motion. All reconstructed pulleys showed less stiffness and more displacement before failure than normal intact pulleys. Although reconstruction using a length of another tendon woven through the remaining fibrous rim of the pulley and both double and triple tendon graft loops around bone absorbed more energy to failure than a normal pulley, only the triple loop around bone could withstand as much load before failure as a normal pulley. No reconstruction restored a normal tendon excursion/joint motion relationship, but reconstruction of the A2 and A4 pulleys restored a more normal relationship than either the “belt loop” reconstruction or a combination belt loop, A2 and A4 reconstruction.

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