Open Access Research Article

Outcomes after A1 Pulley Resection versus Release for Trigger Finger

Porter Young, Mohamed Salar*, Price Sessums, Jeb Williams, and Marc B. Kaye

Department of Orthopaedics and Rehabilitation, University of Florida-Jacksonville, USA

Corresponding Author

Received Date: March 18, 2020;  Published Date: April 06, 2020


A1 pulley excision is a novel surgical technique that involves removing the entire pulley as opposed to merely dividing it. This may provide a solution for patients who are at higher risk of scarring or redevelopment of the pulley tissue, such as patients with diabetes. This study aims to compare outcomes of A1 pulley resection versus the standard release (or division) for patients with trigger finger. We hypothesize that complete resection of the A1 pulley will result in fewer instances of scarring and potential redevelopment of the pulley and subsequent postoperative referrals to occupational therapy (OT), steroid injections, or revision releases when compared to A1 pulley division only. A retrospective review was performed and 90 patients with 137 trigger finger releases were included in the study. Postoperative recovery comparisons as well as operative time were compared between the excision and division groups. Subgroup analysis was performed regarding outcomes of patients with diabetes and hypothyroidism. The excision group demonstrated improved outcomes compared to the incision group with lower rates of digital stiffness requiring OT referral (56% versus 61% p=0.529), a lower rate of repeat injections (10% versus 20% p=0.098) and a lower rate of revision release (2% versus 16% p=0.004). Average operative time was 4 minutes 10 seconds min longer in the excision group. Average follow up was 20.8 weeks in the excision group and 46.3 weeks in the incision group. Excision of the A1 pulley is a novel technique that may successfully reduce the rates of OT referrals and digital stiffness, but successfully reduces the need for postoperative injection, and most importantly, it reduces the incidence of revision surgeries with only a minor increase in operative time. We recommend this option for patients who are at an increased risk for redeveloping trigger finger.

Keywords: Trigger finger; Excision; A1 Pulley; Incision; Recurrence; Diabetes; Hypothyroidism

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