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Evaluating Outcomes of Flexor Tendon Excision During Trigger Finger Release
Joydeep Baidya, BS, Gregorio Baek, BS, Olivia A. Opara, M.D., Nicholas B. Pohl, M.D., Harrison Patrizio, BS, Sebastian Fras, BS, Abbey Glover, BS, Pedro K Beredjiklian, M.D.; Daniel J. Fletcher, M.D.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Introduction: Patients with trigger finger who are refractory to nonsurgical treatments require trigger finger release (TFR) using A1 pulley release, while those with persistent triggering or severe PIP contracture may necessitate additional flexor tendon excision (FTE). The authors hypothesize that outcomes between isolated TFR and TFR with additional FTE will be comparable.
Materials and Methods: Cases at a tertiary care center were retrospectively queried. Chart review was conducted to identify complete patient records, yielding the final cohort of patients who underwent TFR with concurrent FTE. A 2:1 matched isolated TFR group was used for comparison. Patient demographics, complications, and outcomes were compared. Statistical analysis was performed (alpha 0.05).
Results: 8,551 patients who underwent TFR were retrospectively reviewed, among whom 218 (2.5%) required additional FTE. A final cohort of 121 patients undergoing TFR with FTE were matched to 243 patients undergoing isolated TFR. The long finger was most commonly affected across all groups. The proportion of patients who received at least one preoperative steroid injection was highest in the isolated TFR group (68.3% vs 51.4% and 50.0% in the TFR with partial and complete FTE groups, respectively; p=0.003). All other demographic variables, complications, and patient-reported outcomes were comparable between groups.
Conclusion: Our study shows excision of the flexor tendon in select patients with persistent triggering or severe PIP contracture at the time of primary TFR exhibits high rates of postoperative improvement, as well as similar oral and steroid injections, complication rates, and DASH scores compared to the isolated TFR group. Therefore, surgeons should consider FTE in certain indicated cases in order to reduce the need for further surgeries while achieving similar clinical and patient-reported outcomes.
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