Digital Pulley Reconstruction Using Pulley Allografts: A Comparison With Traditional Tendon-Based Techniques

Area of Science:

• Orthopedic surgery
• Biomaterials in reconstructive surgery

Background:

• Previous studies established the safety and feasibility of sterile, acellular pulley allografts.
• No prior comparisons existed between allograft pulleys and tendon-based techniques for pulley reconstruction.

Purpose of the Study:

• To compare the procedural time and clinical outcomes of pulley reconstruction using allografts versus traditional tendon-based techniques.
• To test the hypothesis that allograft pulleys reduce operative time and yield equivalent clinical results.

Main Methods:

• A retrospective review of pulley reconstructions (allograft vs. tendon-based) between November 2013 and November 2015.
• Exclusion of patients with concomitant procedures.
• Data collected included demographics, comorbidities, operative times, complications, and Disability of the Arm, Shoulder, and Hand (DASH) scores.

Main Results:

• Fifteen pulleys in 10 patients were reconstructed (5 tendon-based, 5 allograft).
• Allograft group showed significantly reduced total operative time (46 vs. 89 min) and tourniquet time (34 vs. 63 min; P=0.015 and P=0.014).
• One reoperation in the tendon-based group vs. zero in the allograft group; DASH scores were lower in the allograft group (3.6 vs. 56.8; P=0.11).

Conclusions:

• Pulley reconstruction with allograft is efficient and technically feasible.
• This technique replaces like with like, avoiding donor site morbidity.
• Allograft pulleys significantly shorten operative and tourniquet times.