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Percutaneous Release of the A1 Pulley: A Cadaveric Study
Rohan Ashok Habbu, MS, MBBS; Julie E. Adams, MD; Matthew D. Putnam, MD; University of Minnesota
Univesity of Minnesota department of orthopaedics, Minneapolis, MN, USA

Introduction: Percutaneous release of the A-1 pulley has been used for treatment of trigger digits with success. However, lack of direct visualization raises concerns about completeness of the release and about potential injury to the tendons or neurovascular structures. The purpose of this study was to assess the efficacy and safety of percutaneous release of A-1 pulley in a cadaveric model.

Materials & Methods: Fourteen fresh frozen cadaveric hands (54 digits) were used. Landmarks were established for the A1 pulley based upon cutaneous features. Secondly, percutaneous release was performed using a # 15 blade. Lastly, the specimens were dissected and examined for any tendon or neurovascular injury, and completeness of A1 pulley release was evaluated.

Results: There were 39 (72%) complete releases of the A-1 pulley with 14 partial and one missed release. There was 22% incidence of release of the proximal edge of A-2 pulley. However, there was no case of release of more than 25% of the A-2 pulley length, nor was bowstringing of flexor tendons seen in these specimens. Eleven digits showed longitudinal scoring of the flexor tendons while three had partial tendon lacerations. No neurovascular injuries were noted.

Conclusions: Percutaneous release of the A-1 pulley using a #15 blade was associated with a high margin of safety and effectiveness in this series.

Clinical relevance: Percutaneous release of trigger digits may assume a greater role in the treatment of patients with trigger finger due to cost containment pressures and desires to limit surgery center or operating room use. This study suggests it is both safe and effective. With use of proper anatomical guidelines, risk to neurovascular bundle is minimal, though longitudinal scoring of the tendon can occur.

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