Effect of pulley integrity on excursions and work of flexion in healing flexor tendons

We investigated the effect of incision of a single critical pulley on excursions and work of flexion in healing flexor tendons. Forty-two long toes from 21 white leghorn chickens were used as the experimental model. Gliding excursions of the flexor digitorum profundus tendons and work of flexion of the long toes were studied 8 weeks after tendon repair to determine the functions of the healed tendons in intact, incised, or enlarged A2 pulleys. Eleven additional chickens (22 long toes) were used to obtain tendon excursion measurements in normal chicken toes. At 8 weeks, gliding excursions were statistically smaller in the intact pulley group than in the incised or enlarged pulley groups; the excursions were 73% +/- 4% for the intact pulley group, 88% +/- 9% for the incised pulley group, and 91% +/- 8% for the enlarged sheath group compared with the normal group. Work of flexion of the toes in the intact pulley group was statistically greater than that in the incised or enlarged pulley groups. Excursion efficiency of the flexor tendons was not statistically different among the toes receiving different treatments in the pulley. The results of this study demonstrate that release of a single pulley after repair of the tendons in this area improved gliding excursions of the tendons and reduced resistance to motion of the repaired tendons, and provide support for partial A2 pulley incision after repair of the tendons in the area of the pulley.